Serious reservations about the Kennedy bill

[eridani]

From the NYT summary--

Under the Kennedy bill, individuals would be subject to financial penalties if they did not have health insurance.

Under the bill, the federal government would make grants to the states to establish insurance marketplaces or exchanges. Those entities, known as health benefit gateways, would disseminate information about premiums and benefits and would help people enroll.

This sounds exactly like the utter failure that is the Massachusetts system. I mean failure for sick people of course. Quite a few of the healthy majority are happy with the delusion of "coverage," about which they know nothing, not having ever been expensively sick.

Dr. Rachel Nardin's PNHP testimony--

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7000 before expenses before the insurance pays a single medical bill. It is not surprising that many of the state's uninsured have declined such coverage.

....

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. She told us “Under Free Care I saw doctors at Mass. General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization. Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well.” Now that she's “insured,” Kathryn's medical expenses consume almost one-quarter of her take home pay, and she wonders whether she'll be able to continue taking her life saving medications.

From the PNHP analysis of aobut 2 years ago--
http://www.pnhp.org/news/2007/september/health_reform_failur.php

And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don’t buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

From Public Citizen Health Letter
Public Hospitals and Community Clinics Suffering Under Massachusetts Health Care Reform

Statement of Steffie Woolhandler, MD., Associate Professor of Medicine, Harvard Research Group and Co-Founder, Physicians for a National Health Program

Many remain uninsured in Massachusetts and access to health care continues to be a problem statewide; for many residents it has actually worsened. This is particularly disgraceful given the surge in spending for the reform effort, which has run hundreds of millions of dollars over its original budget. The reform cost $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009.

These high costs have already triggered a new crisis in our state. Last fall Gov. Deval Patrick announced massive cuts to safety net providers including public hospitals and community clinics. As a result, these providers have reduced the care available to the state's remaining uninsured, as well as to others who rely on them for services in short supply in the private sector. These safety net services, which often lose money for hospitals even when patients have good insurance, include emergency care, chronic mental health care and primary care. The public hospital where I work is busier than ever, but has just announced that it will close six community clinics, and about half of its inpatient psychiatry beds—despite critical shortages of primary care and psychiatric services. Most of our poor patients, who previously received completely free care, are now forced to pay upfront co-payments prior to receiving care.

Meanwhile, the reform further encouraged the overuse of expensive, high-technology care. Little known provisions in the bill increased payments for specialty care while cutting reimbursement for primary care. This has further tilted health spending toward expensive, high-tech care and away from the primary and preventive care that is the sine qua non of quality efficient health care.

By requiring that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Patients were forced to help foot the bill for private insurer's high overhead—three to four times higher than Medicare's administrative costs. Moreover, the agency that administers the new law (the "Connector") adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies. And for hospitals and doctors, the new reform has added new administrative burdens and costs.

In contrast, a single payer system of non-profit national health insurance could save $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state's uninsured residents and to improve coverage for those who now have insurance with large co-payments and deductibles, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a wealthy state with the most favorable circumstances. We started out with high levels of medical spending and low rates of uninsurance. Yet even under these near-ideal conditions the reform is failing. It would be a grave mistake to use Massachusetts' reform as a model for the nation.