Massachusetts health care

There’s an article on
this morning called
Bringing Down the House: The
sobering lessons of health reform in Massachusetts
. Slate
is a large organization, and some of the writing is a lot better
than others. This one isn’t one of their better efforts.

The gist of the article is:

The expensive Massachusetts plan is not well-designed to systematically improve anyone’s health. Instead, it’s a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.

In the heat of the moment, I posted this comment:

I think this article ignores the managed care option. I’m sure the discussion of up-front costs and copays is true for some plan that’s available, and it may be the cheapest per month, but my impression is that the purpose of the current cost structure is to drive people to managed care. This gives them hefty copayments for some expensive services, but makes routine preventative care practically free.

My own plan (one of the subsidized ones) has more copays than some
really poor people have, but the choice for the mother whose
baby has a fever would be between paying a $50 copay for the
emergency room and waiting for the doctor’s office to be open
and paying a $5 copay.

Thinking about it while walking the dog, I realized that a
better criticism of the article would be to point out how divorced
from any facts the author’s thesis was. If you want to argue
that a given system discourages care, shouldn’t you feel that you
have to present some statistics that show less care is being used
under the current system than under the previous system?

I’m not an expert, but certainly there have been reports in the
press suggesting the opposite — for instance, that the number of
primary care providers (PCPs) accepting new patients has dropped because
all the people who have insurance now and didn’t before have
signed up for a PCP and are using him or her.

My personal experience of the new Massachusetts system has been
pretty good, once I gave up on figuring out how to apply for the
subsidized care myself and got the social worker at the clinic I
go to to help me.

There are several major things wrong with health care in
Massachusetts, but the insurance requirement discouraging use of
health care really isn’t one of them.

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