Mitt Romney once claimed that he had never suggested that MASSCare would reduce the cost of health care, but his own Boston Globe article showed that wasn’t so. It certainly didn’t lower costs as Romney promised. Bay-Staters and employers there still pay the highest premiums costs in the country. But is this just a free-market response to the bad economy of the last few years? No, and Romney can’t blame subsequent Democrats for the changes in the system since he left office, for all of the regulations and mandates below were in the original Romney plan or left unchanged by Romney.
But Massachusetts Health care hadn’t been about freedom for a long time:
“The 2006 reform built on Massachusetts’ expanded public programs and its highly regulated
insurance market. The state’s small group and individual insurance markets were already
subject to rate regulations that were designed to bring down premiums and provide greater
access to health coverage.”
“required all residents over the age of 18 to obtain health insurance by July 1, 2007.”
“The 2006 reform also requires employers to participate.”
“Insurers were required to submit plans with three different levels of cost-sharing.”
Which one of these parts of Romneycare encourages a free market?
- To Citizens: You must buy insurance, whether you want it or not.
- To Insurance Companies: You must cover people with pre-conditions. You cannot have caps on lifetime coverage.
- To Both: You cannot negotiate for a low-cost catastrophic plan.
- To Both, Respectively: You must cover drug treatment, family planning, mental health problems and pregnancies. You must pay for these things even if you don’t want them or need them.
- To Private Employers: You must cover employees or pay huge “fees” or fines for not doing so.
- To Insurance Companies: You must not raise rates above a certain level, regardless of rising costs.
- To Taxpayers: You must help pay the cost of not only your own insurance, but the insurance of families making $50,000 a year (At least 15% of Massachusetts residents are almost fully subsidized, another 5% get partial subsidies).
The people who manage Romneycare like mandates and regulation, just like Romney does.
On July 1, 2007, the state merged the small group and individual insurance markets
in order to make coverage for individuals more affordable. Individuals who obtain
insurance only for themselves often have above-average medical costs, whereas small
groups share risk and attract people who have a full range of medical costs. Merging
these markets pools risk and lowers premiums for those with individual coverage.
In other words, the group that receives the greatest benefits, must pay lower premiums, which is the opposite of the law of supply and demand known as the free market.
For those who recognize the terms used to ration care (with death panels to follow?), Romneycare created a new bureaucratic state agency called innocuously, “a Quality and Cost Council. The council must set benchmarks for quality improvement and cost containment, collect data on health outcomes and health system spending from providers throughout the state’s health care system, and publish its findings on its Web site.” Among the goals are “population health management” which include taxing high-sugar foods and coercing restaurants into changing their menus. In spite of claims to the contrary, the program intends to impose on all doctors and hospitals such mandates/controls as this one: “reduced payments for avoidable hospitalizations and preventable readmissions.” Another socialist idea in Romneycare is the global payment model, where instead of paying for individual treatments, doctors get paid according to how their patients improve. Of course, this will be an incentive to drop patients who don’t show improvement.
The plan is full of bureaucrats who know nothing about medicine but will be making medical decisions for the population of Massachusetts: “available comparative effectiveness information and analysis should be utilized to develop consensus recommendations for coverage and medical necessity policies”.
To respond to the 100-page PDF document linked to above would take a couple of hundred pages of commentary. Reading it is like reading something out of Animal Farm or 1984. It calls for every single detail of health care to be decided by “scientists” and cost-containment experts.
Another point for those who weren’t paying attention, and only paying more for insurance in Massachusetts, Romneycare even created a form of racial quotas:
“The reform also established a statewide Racial and Ethnic Health Disparities Council to track disparities data and create Pay for Performance benchmarks.”
Apparently, the goal of REHDC is not to reduce actual incidents of diseases, but to narrow the disparities between Italians and Swedes, and even pay people to help the stats to match up.
There is another mandate mentioned by those who support Romneycare: The Reagan era requirement that emergency rooms treat any person who comes in. While this is a legitimate complaint about the current set-up, one cannot take two wrongs and make a right out of it. That law should not have been passed, but it could be removed or changed so that only true emergencies must be treated. Hospitals would have to weigh the risk of not treating someone who might sue, but otherwise could turn away people who refused to pay, when they are able.
Finally, there are those who claim that the previous system rewarded “freeloaders”, who could pay for their care, but didn’t. Because they weren’t insured, tax payers got stuck with the bill. But those freeloaders just got signed up for free or subsidized health treatment, and guess who still pays for their care? The taxpayers, of course. Massachusetts just added more freeloaders, on purpose.
The Romney experiment in health care reform was a failure. But free market economists did know or should have known it from the beginning. Because it was anything but a free-market system.