Earlier 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.