Did Massachusetts' High Quality Health Care System Give Romneycare a Boost?

Whitehouse.govWhitehouse.govEarlier this week, I noted a new study showing a decrease in mortality in Massachusetts following the state's 2006 expansion of health insurance. In that post, I noted that the results might be attributable to some of the unusual qualities of the Bay State's elite health care system. Today, at The Washington Examiner, Philip Klein expands on the same notion: 

The authors of the study themselves note the fact that Massachusetts had the "most per capita physicians in the country" may be one reason why the results may not be generally applicable. So I decided to delve into that a bit more, and I found that according to Census data, in 2006, Massachusetts had 462 doctors per 100,000 residents—which ranked it as the top state. Maryland came next, with 415. By Michigan, the 25th ranked state, the number dropped to 245. And the bottom state, Idaho, had just 169 doctors per 100,000 residents. Because these numbers are from 2006, the year Romneycare became law, they wouldn't have been affected one way or another by the implementation.

But even this may not tell the whole story, because what matters is not just the raw number of doctors, but the quality of physicians as well as the medical facilities that are available—the access to life-saving equipment and cutting edge treatments.

And there's reason to believe that Massachusetts is leader on that front, too. For instance, Massachusetts General has consistently ranked as one of the best hospitals in the U.S. It has an annual research budget of over $750 million, which is the largest in the nation for a hospital-based research program.

Given the data we have, it's impossible to say how likely it is that any of this was a factor in the results, or, if so, how big a role Massachusetts' upscale health care system played. But it certainly seems at least plausible that it's part of the story. 

In some sense, Massachusetts is the state equivalent of a high-quality health system, like Mayo, Geisinger, or Intermountain Healthcare. And one of the things we've seen consistently is that programs that work in those high-quality systems aren't easy to replicate elsewhere. They don't scale up very well most of the time. So assuming that there is some causality at work, it may be that Massachusetts is posting better results from a coverage expansion than other states would. 

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  • Bardas Phocas||

    And I'm sure those Idahoians would be dropping like flies if half of them weren't friggin mormans and so twisting the numbers.

  • Adam330||

    Let's see. We have a number (Rand, Oregon Medicaid) of large randomly controlled studies (i.e. the best kind) showing insurance has no effect on health. We also have a number of studies using regression methods (i.e fairly good but not the best) showing the same. Then we have this single study using a matched case-control design (potentially good, but highly dependent on good design and planning) showing the opposite in a single state at a single point in time. Hmmm....

  • Lord Humungus||

    Narrative! Narrative!

  • Adam330||

    Yes, I have little doubt this is the study that will be cited over and over in the media as "proof." Just like the Krueger study is cited for the minimum wage, and the Perry and Abecedarian studies are cited for universal pre-school.

  • craiginmass||

    Uh, inconvenient truth that many many statistics in MA - over a period of many years show better better health outcomes. It doesn't take a brain surgeon (although we do have the best in the world) to understand that preventative care and being covered beats the opposites.

    It's quite simple. It takes convoluted logic to construct something which shows otherwise.

    A "reasonable" person looks at facts and outcomes. MA leads in most metrics in health of residents, lack of STD's, etc.
    Why? Because we are crazy liberals?

    No, it's because we use government to institute policies which improve the lives of our residents.

    I know...that's hard to imagine if you come from a cynical world view. Just because it's raining outside your window does not mean it's raining everywhere.

  • politicsbyothermeans||

    "No, it's because we use government to institute policies which improve the lives of our residents."

    Prove it.

    Protip: you can't.

  • wrd9||

    Yes, tell us how life was improved for Jeremiah Oliver and the other 94 children who died under DCF care since 2001? Or that it's wonderful that $500 million has been wasted on the state Obamacare website and since it's completely unworkable they are going to spend another $120 million. Or how Matthew Denice's life was improved since he was dragged to death by an illegal immigrant. Not to mention that there have been many other deaths by illegals' hands. Tell me how life has been made better when Deval Patrick says that spending has been cut to the bone and threatens cuts to the elderly and the disabled if taxes aren't raised but then the newspapers find scandals about patronage jobs in the probation department and embezzlement in the local housing authorities?

    I do have a story about Romneycare/Obamacare. I used to go to a great clinic/hospital in Burlington, MA eleven years ago. I took a hiatus for 11 years because I was in good health and returned to the same system 1 year ago. It. was. awful. Before, it was no problem getting an appt with my doctor. Now I still haven't been able to see my PCP for a full year, I keep getting shunted to PAs. And trying to get followup appts are terrible. And the PAs don't listen to you, they have one way or it's the highway. And they make appts to maximize how much money they'll get from insurance. It was never that way before.

  • craiginmass||

    Ah, I get it.

    We have good health care, so it is working even better when RomneyCare/ACA are added to it.

    But the rest of the poor slobs in the USA should not expect to be able to measure up to the Blue States like this one.

    Talk about lack of "reason"! Wow. It takes some convoluted thinking to come up with the conclusion that the ACA won't work....because it WORKS.

    Let me write a better article.

    Sure, health care and society is complex. But the good folks in a "liberal" place like MA decided long ago that they should attempt to make things better for PEOPLE as opposed to just one particular subset of connected folks (Southern Plantation Mentality, still at work today with corporatism)....or for corporations as a whole.

    When a state and the people who live there have concerns about education, environment, health care, etc - they then put RESOURCES and ENERGY (people, money, time, intelligence, planning) toward those goals.

    MA. has done this and it's the reason we have some of the best health care (and results) in the USA.

    Being the original "patriots", we realize that the USA does not stop at our borders. All Americans should have, as the founders put it, the blessings of liberty - among them are happiness and the general welfare (both 100% related to health).

  • wrd9||

    "But the good folks in a "liberal" place like MA decided long ago that they should attempt to make things better for PEOPLE as opposed to just one particular subset of connected folks.."

    What a lot of BS rationalization for the rise of a fascist govt in MA.

    "Fascist states pursued policies of social indoctrination through propaganda in education and the media and regulation of the production of educational and media material. Education was designed to glorify the fascist movement and inform students of its historical and political importance to the nation. It attempted to purge ideas that were not consistent with the beliefs of the fascist movement and to teach students to be obedient to the state."

    If you don't see those tendencies in MA or the federal govt then you're a useful idiot.

  • Master Chief||

    Sure, health care and society is complex. But the good folks in a "liberal" place like MA decided long ago that they should attempt to make things better for PEOPLE as opposed to just one particular subset of connected folks (Southern Plantation Mentality, still at work today with corporatism)....or for corporations as a whole.

    So - what you're saying is that the more local the government, the better-informed and applicable their decisions. Why are you against top-down, Soviet-style, central planning? It has always failed in the past, but this time the right Top Men are in charge.

  • susan221||

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