IT WORKS PRECISELY BECAUSE IT LACKS AMBITION

Health Reform in Massachusetts (NY Times, 5/20/11)

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker. [...]

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Obviously if you make a lot of people buy something they don't need you can lower the cost for the folks who do want it. But was it really a problem that many people didn't have something they don't need? A set of reforms whose primary goal is to have healthy young people buy blanket health coverage makes little sense.

A more sensible goal would be to reform the system so that they can afford care when they actually do need it, which means catastrophic coverage during the healthy years and substantial savings to draw upon during their declining years. One of the great benefits of such a system is that, because money they don't spend belongs to them instead of to an insurer, you get health care cost containment. I don't care if someone else is paying for my bogus test, but at the point where the money comes out of my own pocket I'm not having it done.

Posted by oj at May 21, 2011 6:14 AM
Tweet   

Follow @brothersjudd