Amanda Carey | July 15, 2009
Back in 2006, Massachusetts enacted their own public
option for health care, Commonwealth Care—anticipating the current
debate on the advisability of doing the same thing on the national
level. It was introduced to help residents comply with a new
state law that required everyone to have health insurance. But just
like every other state, Massachusetts has been dealing with a weak
economy. As a result, the number of people enrolling in the public
option have spiked, while funds have
dropped. So the commonwealth is considering semi-arbitrarily
eliminating
30,000 legal immigrants from eligibility.
“It either sends the message that health care reform cannot be done, period,” said Eva Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, “or it opens the door to doing it halfway and excluding immigrants from the process.”
Gov. Deval Patrick has proposed re-adding $70 million—mere pocket change—to the program, though he admits he doesn't know where the money will come from. "I know we don't have very much money, but we made a commitment in this commonwealth to embark down this health care reform path."
Massachusetts should be a warning sign to Congress as they debate legislation that would enact a public option for health care in the middle of a recession. Of course, maybe funding universal health care won't be much of a challenge once they start imposing enormously high taxes on America's wealthiest individuals to pay for it.
Reason's Ronald Bailey on Massachusetts health care here.
Help Reason celebrate its next 40 years. Donate Now!
Try Reason's award-winning print edition today! Your first issue is FREE if you are not completely satisfied.
"Of course, maybe funding universal health care won't be much of
a challenge once they start imposing enormously high taxes on
America's wealthiest individuals "
You have interesting priorities. Wouldn't you rather tax people who
have money to spare than let masses of people go without access to
health care?
The unavoidable fact is that the U.S. has a woefully inefficient
health care system. It spends more money than single-payer nations
do, and achieves worse outcomes.
Government is like the movies - you have to suspend disbelief in order to accept it.
Screw the evidence, we have the right people in charge, and they'll surely do it better.
Can't get any funnier than the NYT picture caption:
"Laura Porto, 58, a legal immigrant from Venezuela, said that
losing her state-subsidized health coverage would force her to stop
treatment for bipolar disorder."
Massachusetts wouldn't have a problem if the state were allowed to print money.
The law requires that almost every resident have insurance,
and to meet that goal, the state subsidizes coverage for those
earning up to three times the federal poverty level
Another easy solution: cheat on the calculation of the federal
poverty level. Should be easy to do during a recession.
Wouldn't you rather tax people who have money to spare than
let masses of people go without access to health care?
I would rather not tax at all.
Everyone has access to health care. Pay cash and the doors are
wiiiiiiiiiiiiide open.
How much more fucking access do you need?
The health care debate seems to be playing out like a classic US
federal govt top-down quick "fix".
Has there really been much serious analysis of why exactly health
care costs in the US are significantly higher? A friend of mine is
an American finishing her MPH in Europe, and has pointed out that
if lower doctors' fees are really desired, then the US Govt will
need to look at how they can make it easier/cheaper to become a
doctor, and how to lower costs like those malpractice related. This
isn't an easy or fast process of course - changing the MD to a
modified undergraduate degree program (as in pretty much all other
countries) would be an important step but wouldn't have an effect
for a significant period of time.
Unfortunately I suspect that many changes that will occur over the
next few years will probably do little to cut costs, and may reduce
quality.
On the other hand, I was frequently shocked by the price of
prescription medicines when I lived in California - surely
Americans are paying too much for them. Why exactly?
The unavoidable fact is that the U.S. has a woefully
inefficient health care system. It spends more money than
single-payer nations do, and achieves worse outcomes.
Both sentences are false.
In addition to dropping the immigrant insurance program,
Commonwealth Care will save an estimated $63 million by no longer
automatically enrolling low-income residents who fail to enroll
themselves.
Health care for everyone, but please don't enroll!!
On the other hand, I was frequently shocked by the price of
prescription medicines when I lived in California - surely
Americans are paying too much for them. Why exactly?
Americans are subsidizing European prescriptions.
One example, if the US system provides worse outcomes, then how
come if you cut off your fingers in Israel, you fly to Louisville
KY to get them sown back on?
Why not Tel Aviv or Paris or London?
The answer: The Hand Center at Jewish Hospital in Louisville has
all the best fucking hand doctors in the universe. Why? Because the
US system is better than all the places they come from.
Americans are subsidizing European prescriptions.
Sure, that's a consequence, but why is that the situation?
Can't the state just start another lottery with all proceeds
going to health care?
I wanna see Bi-Polar Scratch-offs!
Public Option In Mass. Costs Too Much. Let's Do It
Nationwide!
Or, In Government, Nothing Succeeds Like Failure!
Sure, that's a consequence, but why is that the
situation?
We volunteered for it.
Sure, that's a consequence, but why is that the
situation?
In socialized systems the countries buy in bulk. They negotiate a
lower price. The drug companies will sell to them because the price
beats the marginal price of making the drugs and the US clientele
pay the higher price to cover the R&D. This works because the
foreign companies would pull the patent protection if the companies
held out and refused to sell and the generic price is even
lower.
If every country tries this, it doesnt work, because it kills the
R&D off.
If every country tries this, it doesnt work, because it
kills the R&D off.
That's US volunteering for it.
"Screw the evidence, we have the right people in charge, and
they'll surely do it better."
Wouldn't this apply equally to our current private sector
insurance-health care system? In a lot of ways very noticeable to
more and more Americans, it doesn't seem to be working very
well...
"If every country tries this, it doesnt work, because it kills
the R&D off."
C'mon, it's up to us to us to sacrifice for the sake of the entire
world!
Surely Medicaid (that's the prescription drug benefit agency?) and the large insurance companies buy in Bulk too - they must be larger than many developed nations' bulk buyers, so shouldn't they be able to get a significantly better deal? And if Euro contries threaten to pull patent protection, surely the US could do the same thing in response?
Wouldn't this apply equally to our current private sector
insurance-health care system?
Absolutely. Insurance is no different than fractional-reserve
banking. When there's a run on the insurance company, some members
suddenly fins their claims are denied. A government-run insurance
plan will run exactly the same way.
"Has there really been much serious analysis of why exactly
health care costs in the US are significantly higher?"
TONS.
Start here
robc
As long as the price negotiated between the U.S. government and the
drug companies meant a profit was still to be made, they would keep
making drugs, investing in R&D, etc. Sure, logic would suggest
that the lower the profits the less of this may go on, but as long
as there is some money to be made I wouldn't sweat it.
Really.
If people always acted along the lines of the hard core libertarian
rhetoric I often hear then one would expect heavily regulated and
taxed places in Scandanivia to be devoid of businesses and wealth
production. But they are not. Sure, if you raise taxes or
regulation, it should, at the margins, perhaps make business owner
A or B decide not to open that new store, but it's unlikely he's
going to close all his shoips to go home and eat his capital just
because his profits go from buying him yachts to just
speed-boats...
Sorry Sean, I know that there has are a lot of health depts in American universities etc, but I meant in the current federal plan and congressional debate. i.e. Has there been much serious study presented as a part of it as to how costs would be/should be reduced?
Hilarious: Reason is using 90s-era clip art, the same kind used in, for instance, an OnlineDrivingSchool I took once.
"they must be larger than many developed nations' bulk buyers,
so shouldn't they be able to get a significantly better deal"
IIRC the GOP decided not to do this when they revamped the
prescription drug plan. You know, because markets blah blah blah or
something like that...
IIRC that is how Wal-Mart brokered their sweet deal with the
drug companies.
WM: "Oh, you don't like the price we want? OK then, we'll take our
gazillion customers elsewhere."
Drug-Companies: "Oh, I think we could find a way to do what you
want..."
But to have the government do this sensible thing would be wrong.
Again, because markets blah blah blah or something.
dbcooper, read that link, if you're interested.
And I don't think the government is particularly interested in
understanding why costs are higher now. All they
particularly care about is the "crisis" of it costing too much and
then expanding powers of government in order to "solve" the problem
- not realizing that if they read some history once in a while and
realized that their various means of price & wage controls,
regulations, interventions into the market, subsidies (thereby
increasing demand artificially), and licensing processes are
exactly what's caused the price increase to begin with.
Sadly, this is commensurate with my experience with government at
all levels, starting with my high school's school board, through my
colleged public policy center job, through state assembly all the
way up to the big leagues.
The only solution is to give government officials more
power, take more money and lumber about with more force. Nothing
else is considered or attempted.
But as usual, previous government attempts to manage health care
and fix little problems have turned into massive problems
instead.
"various means of price & wage controls, regulations,
interventions into the market, subsidies (thereby increasing demand
artificially), and licensing processes are exactly what's caused
the price increase to begin with."
One reason I am skeptical about this is that other nation's with
higher levels of this kind of thing have...lower costs...
As long as the price negotiated between the U.S. government
and the drug companies meant a profit was still to be made, they
would keep making drugs, investing in R&D, etc. Sure, logic
would suggest that the lower the profits the less of this may go
on, but as long as there is some money to be made I wouldn't sweat
it. Really.
WTF?
The next step isn't going to be less R&D, it's going to be
publicly-funded, politically motivated R&D. At that point it's
nothing but lying about the figures. You either get solar-power
dialysis or nothing.
Yes, your health care costs have gone down. Please ignore the
quintupling of your other costs because those are in different
accounts.
MNG... the government already pays for roughly 60% of health
care. I think we've covered this before. Further, they
typically underpay for services, pushing costs onto doctors and
hospitals - which raises the cost of private insurance to make up
for government asshattery.
Point being, they do buy in bulk, and they
underpay... which means they're getting a "better" deal than
Wal-mart could hope for, and yet they're still going bankrupt and
costs have increased dramatically... not surprisingly to anyone who
actually does understand economics - the increased cost of
health care corresponds nicely to the increase in government
involvement.
THIS IS IT!
The healthcare reform bill released by the House Of Representatives
is an excellent bill as I understand it. It is carefully written,
and thoughtfully constructed, informed, prudent and wise. This bill
will save trillions of dollars, and millions of your lives.
This is the type of bill that all Americans can feel good about.
And this is the type of bill that has the potential to dramatically
improve the quality of healthcare for all Americans. Rich, middle
class and poor a like. Democrats, Republicans, Independents, and
all other party affiliations. This bill has the potential to
dramatically improve the quality of life of every American.
The house healthcare bill should be viewed as the minimum GOLD
STANDARD by which all other proposed healthcare legislation should
be judged. All supporters of true high quality healthcare reform
should now place all your support behind this healthcare reform
bill released by the United States House Of Representatives, as the
minimum Gold standard for healthcare reform in America.
You should all now support this bill with all your might, and all
of your unrelenting tenacity. This healthcare bill is a VERY, VERY
GOOD! bill for all of the American people. Fight tooth, and nail
for every bit of this bill if you have too. Be aggressive,
creative, and relentless for this bill.
AND FIGHT!! like your life and the lives of your loved ones depends
on it. BECAUSE IT DOES!
SPREAD THE WORD
(http://www.youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded)
God Bless You
Jack Smith - Working Class
On the other hand, I was frequently shocked by the price of
prescription medicines when I lived in California - surely
Americans are paying too much for them. Why exactly?
Why were you not shocked by how much more expensive EVERYTHING ELSE
is in Europe, asshole?
Thanks for the reply. Article is bookmarked and will be read during the commute!
One reason I am skeptical about this is that other nation's
with higher levels of this kind of thing have...lower
costs...
Don't mistake lower prices for lower costs. Subsidies hide
costs.
Why were you not shocked by how much more expensive
EVERYTHING ELSE is in Europe, asshole?
Uhh, thanks for the insightful, rah-rah, reply mate.
Damnit MNG... I'm so tired of explaining all this shit to
you.
1. Other countries benefit immensely from the costs that
Americans currently bear for development of medical
technology.
2. Governments. Lie.
let me quote Russ:
"
Yes, your health care costs have gone down. Please ignore the quintupling of your other costs because those are in different accounts."
If you don't yet understand that there is nothing remotely honest
about government accounting methods I cannot help you with
that.
3. RATIONING.
When you simply deny people any access to treatment, you have a
capped level of doctors & hospitals, not to mention machinery
& drugs that you'll pay for, you can definitely hold costs
"down". Of course... the trade off is more people dying of things
like cancer.
That was one classy comment you made at 6:12 Invisible
Finger.
It kind of helps not to accuse everyone of being a commie-pinko
queer.
Sometimes someone might just want an answer.
IIRC that is how Wal-Mart brokered their sweet deal with the
drug companies.
What sweet deal are you talking about?
Everything else in Europe is insanely expensive though... like... wtf expensive. Fucking... 25% VAT bullshit.
Sometimes someone might just want an answer.
I gave an answer, free of charge. I also gave an ad hominem. If you
can't see the answer because of the ad hominem, that's your problem
not mine. If you want free answers, you should expect shitty
customer service with it.
Wouldn't you rather tax people who have money to spare than
let masses of people go without access to health care?
Just how many such people actually exist? If the wealthy are a
small slice of the population, the total amount of money you
collect from them--even with confiscatory tax rates--isn't going to
come close to paying for universal health care.
Russ, I think he's talking about their $4 prescription
drugs.
Those aren't provided by sweet deals with the drug companies. They
are being subsidized by other parts of the business. Long-term, it
ain't sustainable.
Everything else in Europe is insanely expensive though...
like... wtf expensive. Fucking... 25% VAT bullshit.
Even with the high VAT, a lot of stuff was still cheaper than in
the bay area though ... Yeah, I know that the bay area is a very
expensive place etc.
Wouldn't you rather tax people who have money to spare than
let masses of people go without access to health care?
What crime did these people commit that allows you to take a
disproportionate amount of their property for the same
benefits?
And the quote never gets old on healthcare reform from a
Massachusetts healthcare reformer:
"Expanding coverage is easy compared to controlling
healthcare costs. Nobody has to give much up to expand coverage,
but in controlling cost there will always be losers." --
Nancy Turnbull, Commonwealth Health Insurance Connector board
member and associate dean at the Harvard School of Public
Health.
"Even with the high VAT, a lot of stuff was still cheaper
than in the bay area though ... Yeah, I know that the bay area is a
very expensive place etc."
When the Bay area sports $15 Big Macs and around 40% higher costs
for every consumer good imaginable, then let's talk.
Even with the high VAT, a lot of stuff was still cheaper
than in the bay area though
Examples? I'm curious.
When the Bay area sports $15 Big Macs and around 40% higher
costs for every consumer good imaginable, then let's
talk.
Well, more like $5 Big Macs in Denmark, and $3 in the UK.
Russ 2000: I found rent (definitely not in London though) and
decent quality groceries to generally be cheaper. Cocktails not so
much ...
Everything depends on the exchange rate at the time of course
...
bdcooper,
FWIW, most of the Europeans I know have raved about how cheap the
food is in the U.S.
Well specifically, I was referring to Copenhagen, which last I checked is in Denmark, and last I was there (about 9 months ago), the cost was around 10 Euro. Which... At the time, was roughly $15.
Then again, Europe generally has shitloads more intervention of the state into food production, etc. than is the case in the U.S.
Disclaimer: Was speaking of the McD's in the expensive part of downtown Copenhagen - not on the outskirts... Which I was going to note has depressing, projects-looking apartments.
Even with the high VAT, a lot of stuff was still cheaper
than in the bay area though ... Yeah, I know that the bay area is a
very expensive place etc.
I have found that in Europe the essentials are cheaper (food like
produce meats chesses etc.) whereas prepared/packaged/ready to eat
food is more expensive.
Non-essential items (electronics -- tv's computers wahsers and
driers) tend to be more expensive as well as the cost of utilties
(telephone, and electric)
Things like automobiles seem to have been about the same although
they tend to levy taxes on cares that have larger engines (in
greece there was a tax on any car with an engine over 2.0L) -- but
it's a bit harder to compare since they have different models of
cars there (Like GM's Opel brand is available in Europe, but not
out here)
At least that's what i noticed
Do not ever say that the desire to "do good" by force is a good motive. Neither power-lust nor stupidity are good motives.
db,
You could probably find large price discrepancies on decent quality
groceries and especially rent between the bay area and St.
Louis.
What about lesser-quality groceries and rent in, say, a less
desirable part of Oakland?
I remember eating in Burger King there (but not McDonald's), and it was more like DKK30 - around $6. I genuinely surprised that you paid 10 euro for junk food in Copenhagen - you could get much better from a shwarma guy for about 200 to 300 DKK. I really meant groceries (I seldom eat fast food) - my local Irma (in a fancy neighbourhood) was cheaper than Andronicos.
I didn't. I just make note of prices when I travel. I'm a culinary enthusiast and I don't eat McDonald's at home, much less in other countries.
So the U.S. compared to European countries: http://www.globalpropertyguide.com/Europe/Portugal/currency-value
A buddy of mine (with a rather insatiable appetite and an unfortunate inability to do monetary calculation) did eat at McD's though and spent a bit over 25 Euro for 2 meals... Which you know... was close to $40 at the time.
"This isn't an easy or fast process of course - changing the MD
to a modified undergraduate degree program"
Remind me to never leave the USA.
Remind me to never leave the USA.
Jingoism is pretty lame at the best of times ...
How many times do I have to say this? Just die. It's really,
really cheap and it's going to happen eventually anyway.
Our unsustainable healthcare system is the fruit of our
unsustainable narcissism.
I've successfully traded service for service for health care and dental care. Both times I had no health insurance by choice, and actually came out financially ahead by not participating in the traditional system. Granted I was not severely ill, but the assumption that there is no health care without insurance is wrong. It may be rare.
"When you simply deny people any access to treatment, you have a
capped level of doctors & hospitals, not to mention machinery
& drugs that you'll pay for, you can definitely hold costs
"down""
If we were to bring in a trading componant, we could have
healthcare cap & trade.
"Jingoism is pretty lame at the best of times ..."
WTF??? You want a MD coming out of a "modified undergraduate degree
program" probing your brain?
Never mistake pragmatism for jingoism. Two very separate
things.
I have found that in Europe the essentials are cheaper (food
like produce meats chesses etc.) whereas prepared/packaged/ready to
eat food is more expensive.
This is true. But rent, for example in Barcelona, is quite high,
and the kicker is that salaries are so damn low. Many people must
have roommates just to have an apartment in the city. Salaries are
low because they are delivered after taxation, which is brutal.
Sure, you get free medical care and free school, but your income is
pitiful.
WTF??? You want a MD coming out of a "modified undergraduate
degree program" probing your brain?
Never mistake pragmatism for jingoism. Two very separate
things.
Yeah, cause all other countries' doctors are shit. I hear they are
just terrible in Switzerland, New Zealand, Australia, etc. In fact
you can only get dependable doctors in America. Do you realise how
ignorant that sounds?
Doctors do 5+ year medical degrees that they start as an
undergraduate in pretty much every other country.
"Yeah, cause all other countries' doctors are shit. I hear they
are just terrible in Switzerland, New Zealand, Australia,
etc."
Listen, cunt, are the doctors in the country you reference the
fruit of a "modified undergraduate degree program"?
Cunt.
"Doctors do 5+ year medical degrees that they start as an
undergraduate in pretty much every other country."
I have a hard time believing that a five year degree is as good as
a the 12+ years it takes to become adoctor in the US.
I too am dubious... But hey - handing out MD's to just about anyone who wants one would totally bring costs down.
I have a hard time believing that a five year degree is as
good as a the 12+ years it takes to become adoctor in the
US.
You are not comparing apples to apples, or degrees to
degrees. In NZ for example, you may be an MD after 6 years, but it
still requires several more years of clinical practice/training to
be a registered surgeon. By skipping a prior bachelors I believe
that they would spend more time in med-school than US students.
That hardly qualifies as "handing out MD's to just about anyone who
wants one." In fact, I'd quietly suggest that it's superior.
A friend of mine (surgeon at UCLA, med school UCSF) did a
sabbatical in Vienna and found the clinical practice to be just as
good.
"A friend of mine (surgeon at UCLA, med school UCSF) did a
sabbatical in Vienna and found the clinical practice to be just as
good."
[citation needed]
What this post doesn't mention is that the architect of the
Massachusetts' plan will likely be the Republican nominee in
2012.
We're screwed.
What this post doesn't mention is that the architect of the
Massachusetts' plan will likely be the Republican nominee in
2012.
Not if we all get behind libertarian-leaning Sarah Palin!
"In NZ for example, you may be an MD after 6 years, but it still
requires several more years of clinical practice/training to be a
registered surgeon."
Withe regard to the MD's, my, how Russian. Are they mostly
women?
With regard to the registered surgeon, it isn't just six years. Are
the mostly men?
"I would rather not tax at all.
Everyone has access to health care. Pay cash and the doors are
wiiiiiiiiiiiiide open.
How much more fucking access do you need?"
How about access that doesn't put you in debt for the rest of your
life if you need major surgery but don't have the income to pay for
it?
"Just how many such people actually exist? If the wealthy are a
small slice of the population, the total amount of money you
collect from them--even with confiscatory tax rates--isn't going to
come close to paying for universal health care."
They are a small slice of the population, but they have
disproportionate wealth.
"What crime did these people commit that allows you to take a
disproportionate amount of their property for the same
benefits?"
What crime did the poor commit that allows you to deny them needed
health care? That crime far outweighs taxation.
"What crime did the poor commit that allows you to deny them
needed health care? That crime far outweighs taxation."
I think that people are hungry, frightened, sick and dying
somewhere on Earth, and here you sit posting on message boards.
Fiend!
Go save them! You're morally obligated to help everyone deal with
everything that our shitty world throws at them, regardless of the
cost to yourself! How can you live with yourself, just sitting
there?
Go "me"! Clint, you have it way in reverse: what did I
do that I am somehow now "responsible" for the state of a person,
even though I had no hand in getting them to that sorry state in
the first place?
In other words, I didn't fucking make them poor, so why should I
have to pay to fix mistakes I didn't make?
Clint, reason.com has several articles that will challenge your
idealistic belief in government-run healthcare, if you are
interested in challenging yourself.
How about access that doesn't put you in debt for the rest of
your life if you need major surgery but don't have the income to
pay for it?
I'm not an expert on government health care systems, but I'm
dealing with planning health care for aging parents and
parents-in-law. We've been warned by more than one adviser that
California's Medicare supplement requires exhaustion of personal
and spousal assets, and that they will go after the estate of the
deceased if they suspect that any assets were not disclosed.
They are a small slice of the population, but they have
disproportionate wealth.
Well, if you're interested there have been recent posts right here
on the Hit & Run blog about the likely costs of the new Federal
health care plan far exceeding the official numbers. That is, far
exceeding expenses that could be paid for by a tax restricted to
only "the rich".
What crime did the poor commit that allows you to deny them
needed health care? That crime far outweighs taxation.
I don't have a problem with providing a safety net for the poor,
but single-payer insurance and perpetuation of employment-tied
insurance goes way beyond providing a safety net.
Wouldn't you rather tax people who have money to spare than
let masses of people go without access to health care?
If you wouldn't steal your neighbor's car, you shouldn't be
stealing your neighbor's money.
From the very first comment:
The unavoidable fact is that the U.S. has a woefully
inefficient health care system. It spends more money than
single-payer nations do, and achieves worse outcomes.
Define health care, and the expenditures encompassed by that term.
Last time I checked, this country is stocked with billionaires, and
starlets, both of whom spend huge amounts of dollars on marginally
beneficial healthcare, from boob implants to tummy tucks to the
best cancer care money can buy. Does those types of spending factor
into your equation?
"Wouldn't you rather tax people who have money to spare than let
masses of people go without access to health care?" - Clint
No. responsible adults should pay for their own health care. Where
did you get the arrogance that enables you rationalize funding your
priorities with other people's resources because you assume it's
"spare"?
Wouldn't you rather tax people who have money to spare than
let masses of people go without access to health care?
Frankly, no. This is a false choice. This country is jammed to the
gills with non-profit healthcare providers who will provide care to
people without regard to ability to pay. Allow hospitals to control
access to their ERs, and you could drive down the cost of providing
care to the uninsured. Lower taxes by shedding the government cost
of providing healthcare, and you would have much more money
available to fund the reduced costs of providing non-profit
care.
I remain firmly unconvinced that government-funded welfare programs
are the only way to deliver care to poor people.
nice post..
___________________
Britney
The
best place for the best ENTERTAINMENT
Site comments/questions:
Media Inquiries and Reprint Permissions:
(310) 367-6109
Editorial & Production Offices:
3415 S. Sepulveda Blvd.
Suite 400
Los Angeles, CA 90034
(310) 391-2245