Monday, June 4, 2007

Excellent Critique of the Massachusetts Program

Sandy Szwarc, BSN, RN, CCP, has written an excellent and detailed criticism of the moves towards government-run "universal care" in Massachusetts, Minnesota, and California. Among the many excellent points she makes, this one stood out the most to me:
One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets.
The whole thing is worth reading, but I'd like to highlight parts of her discussion of Massachusetts. The Massachusetts program, signed into law by Governor (and Republican presidential candidate) Mitt Romney, is one that's frequently cited by advocates of socialized medicine as a model for the US. (The items in bold are my emphasis, not hers):
"Free universal health care for everyone" sounds wonderful and seems to be the vision most repeated in media, but what would that actually look like?

...Citizens' Council on Healthcare (CCHC), a nonprofit patient and physician advocacy organization, did an analysis of the Massachusetts plan last year and made troubling conclusions about its impact for consumers. While the plan was created "to expand access to healthcare for Massachusetts residents, increase the affordability of health insurance products, and enhance accountability of our state’s health system," they found the plan would create an enormous set of new bureaucracies (no less than ten new agencies, six financial-management funds, and three new programs) to establish, oversee and enforce. There is no evidence to suggest that the government will do things cheaper, better or more efficiently.

The MA state plan essentially creates a monopoly of insurers residents can choose from. Every policy has to comply with the state's coverage mandates, and mandates always cost more money than they claim to save. There are thousands of insurance mandates that have been passed by state legislatures over recent years and behind every mandate is a special interest that will benefit by the product or service. A recent analysis by the Council for Affordable Health Insurance estimated that mandated benefits increase the cost for basic health insurance for everyone by 20% to more than 50%, depending on the state. Worse, a number of these mandates are for preventive "wellness" programs, screenings and treatments that are unsound, ineffective, costly, unproven, unwanted or potentially dangerous.

One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets. The government has catered to special interests and created an insurer managed care system, which has resulted in higher premium costs and more people uninsured. Those who want affordable insurance alone, without a third-party managed care bureaucracy standing between them and their doctor, find it unavailable...

...Cost containment efforts will likely drive away healthcare providers and, as has been seen in other single-payer systems, result in shortage of providers and services; rationing of available care and resources; and long waits for tests, surgeries and treatment.

Health insurance coverage is not the same as access to care.

...Overall, Twila Brase, RN, president of CCHC, said of the plan:

[A]n intrusive and prescriptive bureaucracy will be authorized to ration health care and make decisions about who gets what health care when. Health-care decisions will be taken out of the hands of patients and doctors as the agendas of special interests, not the needs of patients, take precedence. The legislation is extremely intrusive.
To sum it up: People will have no choice but are being forced to buy the insurance plans the state dictates. But these are not health insurance plans, as might be believed or some might desire, which protect people from catastrophic health problems, this is managed care. The state is also the regulator, payer and enforcer — a recipe for conflicts of interest.
(Hat tip to MikeN.)