Friday, June 24, 2011

A Mass mess

The Economist checks in on the state of Obamacare Jr. (Sr.?):
[Romneycare] has plainly succeeded in its main goal of expanding health coverage. Just 1.9% of residents lacked insurance in 2010. Other data, though, are more troubling. Access to health insurance does not guarantee access to health care [emphasis mine]. One in five working-age adults say they have trouble finding a doctor who will see them. The Connector, the state’s exchange, has excelled at enrolling uninsured adults in subsidised care, but has failed to attract small businesses and their employees. As of March just 3,644 workers bought coverage on the exchange through their employers.

Costs, meanwhile, are unsustainable. Spending on MassHealth, the programme for the poor, rose 40% between 2006 and 2010. The subsidised health programme for adults was more expensive than expected—$628m in 2008 and $805m in 2009, 32% and 11% above projections respectively. This was offset in part by falling costs for a smaller cohort of uninsured, who tend to turn up for treatment at emergency rooms from which they cannot, by law, be turned away: the figure dropped from $652 billion in 2006 to $414m in 2009. But the decline was less dramatic than many hoped, says Amy Lischko, a professor at Tufts University who helped write the law. And demand from the uninsured now seems to be rising. Last year the number of uninsured hospital visits reached 800,000, 14% above the level in 2009.

For those who do have insurance, average monthly premiums rose by 12% between 2006 and 2008. True, a higher share of firms now offer coverage, but they are also shifting costs for that coverage to employees. Various factors may be to blame. Clunky regulations for the health exchange failed to prompt competition, argues Robert Moffit of the Heritage Foundation. Low reimbursement rates for MassHealth may push hospitals to shift more costs onto the privately insured. And the state’s attorney-general has found that hospitals are using their market dominance to push up prices.
The bolded text deserves to placed in big neon letters on billboards across the country. It is a fundamental truth that everyone with even a tangential interest in the health care debate needs to understand: health insurance coverage and health care are not the same thing. Someone without health insurance can still have access to medical attention while those with insurance can struggle to obtain care.

Other highlights:
  • Massachusetts' health exchange is not working as the central planners anticipated.
  • Costs, described as "unsustainable," are significantly higher than what central planners anticipated.
  • Savings from emergency room visits foregone by the previously uninsured were smaller than what central planners anticipated.
  • Health insurance premiums have increased at a rapid clip.
As the evidence continues to pour in confirming the gaping shortcomings and failures inherent in Romneycare-style government interventions in the health care sector, the position of those who support such an approach is increasingly tenuous. Indeed, at this point advocacy for expanded government intervention must be regarded as borderline theological, as its efficacy appears to be more rooted in faith than observable facts or experience with such systems. Central planning does not work because it cannot work. Repeating such experiments despite past failures is the definition of insanity.

There is no mystery of how to improve the health care sector -- simply free the market. While some argue that health care is beholden to unique characteristics which render the free market model impractical (thus clearing the way for government), the reality is that the health care sector is governed by the same laws of economics that apply to the rest of the marketplace. This isn't idle theorizing, it is what we see borne out in reality.

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