As the experiment has progressed we see more insurance company scandals driving up costs and more problems and little success. Nevertheless, the Democratic party leadership including Obama and Senators Baucus and Kennedy are continuing to push this, despite the serious shortcomings and exploding costs of the actual Massachusetts experience.

As you can tell by browsing the links above, from the government's point of view, the main problem has been escalating costs. Indeed, part of the big lie around the Massachusetts program is that it only passed because the principals agreed to lie about and ignore the issue of cost control.

Because you cannot control costs, and cover everybody, and have coverage that actually covers all needed care, and also keep the for-profit insurance companies in the as an uncecessray middleman. In fact Massachusetts made matter worse by adding an additional administrative layer, the so-called "connector" that adds an additional 4-5% overhead, that would also be eliminated if we just had the automatic enrollment of everybody with single payer.

From the patients's point of view, costs have gone up while what is actually covered under their plans varies and sucks. What is actually required to be covered is pathetic. Universal apparently still does not require coverage radiation and chemotherapy (don't have legally acceptable "unviersal" plan and get cancer), maternity and newborn care (or get pregnant), and diagnostic imaging (be sick and need an x-ray) and screening tests (ask for routine preventive care). Other than those items it is what they call "Universal."

Here are some patients' stories that give a further sense of the failings of this type of "unversal reform."

Now there is an up-to-date full report(.pdf) on the shortcomings of the Massachusetts plan as of February 2009.

As report co-author Rachel Nardin, M.D., President of the Massachusetts Chapter of Physicians for a National Health Program points out health insurance is not synonymous with health care:

In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform, we know a lot about what has worked and what hasn’t. Examining this data critically is vitally important as the Obama administration considers elements of Massachusetts’ plan as a model for national health care reform. The Massachusetts reform is an example of "incremental" reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). The reform has reduced the numbers of uninsured, although our report (.pdf) shows that the state’s claim of near-universal coverage is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones – two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in the state may well be even higher than 5 percent. Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7,000 before the insurance pays a single medical bill. It is not surprising that many of the state’s uninsured have declined such coverage. The study (.pdf) we are releasing today also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state’s old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent Boston Globe/Blue Cross Foundation survey, 13 percent of people with insurance in our state were unable to pay for some health services that they had received and 13 percent could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost. I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs 12 prescriptions a month to stay healthy. She told us, "Under Free Care I saw doctors at Mass General and Brigham and Women’s hospital. I had no co-payments for medications, appointments, lab tests or hospitalization ...Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That’s $340 per month, provided I stay well." Now that she’s "insured," Kathryn’s medical expenses consume almost one-quarter of her take home pay and she wonders whether she’ll be able to continue taking her life-saving medications.

So: Many remain uninsured in Massachusetts and actual access to health care continues to be a problem statewide and for many residents it has actually worsened! As Dr. Woolhandler a primary care physician in Massaschusetts and Associate Professor of Medicine at Harvard Medical School who was also a co-founder of Physicians for a National Health Program points out:

These high costs have already triggered a new crisis in our state. Last fall, Gov. Deval Patrick announced massive cuts to safety-net providers including public hospitals and community clinics. As a result, these providers have reduced the care available to the state’s remaining uninsured, as well as to others who rely on them for services in short supply in the private sector. These safety-net services, which often lose money for hospitals even when patients have good insurance, include emergency care, chronic mental health care and primary care. The public hospital where I work is busier than ever, but has just announced that it will close six community clinics, and about half of its inpatient psychiatry beds – despite critical shortages of primary care and psychiatric services. Most of our poor patients, who previously received completely free care, are now forced to pay upfront co-payments prior to receiving care. It is not surprising that a recent survey of Massachusetts residents directly affected by the reform found that they were more likely to have been hurt by the reform than helped. Meanwhile, the reform further encouraged the overuse of expensive, high-technology care. Little-known provisions in the bill increased payments for specialty care while cutting reimbursement for primary care. This has further tilted health spending toward expensive, high-tech care and away from the primary and preventive care that is the sine qua non of quality, efficient health care. By requiring that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Patients were forced to help foot the bill for private insurers’ high overhead – three to four times higher than Medicare’s administrative costs. Moreover, the agency that administers the new law (the "Connector") adds an extra 4 to 5 percentage points to the already-high overhead of private health insurance policies. And for hospitals and doctors, the new reform has added new administrative burdens and costs. In contrast, a single-payer system of non-profit national health insurance could save $8 billion - $10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance with large co-payments and deductibles, without any increase in total health care costs. The Massachusetts reform law is not providing universal access to care, even in a wealthy state with the most favorable circumstances. We started out with high levels of medical spending and low rates of uninsurance. Yet even under these near-ideal conditions the reform is failing. It would be a grave mistake to use Massachusetts’ reform as a model for the nation.

Sidney Wolfe M.D., Director of the Public Citizen Health Research Group chimed in:

Albert Einstein once said "The definition of insanity is doing the same thing over and over again and expecting different results." In this case, the insanity of doing the same thing over and over again and expecting different results is the 20-year history of state health insurance reform legislation in the United States, detailed at the end of the report being released today and involving nine different states. Although these reforms differed in detail, they shared common elements. All states offered new public subsidies or expanded Medicaid for poor and near-poor people. All left the majority of private health insurance arrangements undisturbed. As the state charts in the report document, all of these failed to have a lasting effect on the problems of uninsured people in those states. State experiments are an important way of trying out programs, which, if they succeed, can go national. In this country, Wisconsin programs for social security were an important predecessor to the Federal Social Security Act in 1935. But if the programs repeatedly fail, to keep experimenting on people by repeating the same set of mistakes in different states, let alone using this private-public model for national health insurance, is nothing short of exemplifying Einstein’s definition of insanity. It should not take a psychiatrist to diagnose or treat this insanity. Roll back the clock to 1962 when in the Canadian province of Saskatchewan there was a similar problem of many uninsured people, private health insurance companies for those wealthy enough to afford such insurance and the quandary of how to address the problem. Saskatchewan enacted a single-payer health insurance system that year and after nine years of very positive results, the system was instituted throughout Canada. The major difference between the Canadian system and ours is the enormous cost savings in Canada of eliminating the private health insurance industry and all of the administrative waste it foists on doctors, hospitals and other health providers. Today’s report estimates that a single-payer system of non-profit national health insurance could save $8 billion to $10 billion annually in Massachusetts alone through reduced administrative costs. This is an amount far in excess of the rapidly escalating annual cost ($1.3 billion in fiscal 2009) of the Massachusetts plan. Unlike the current plan, which literally robs Peter to pay Paul by taking money from critical safety-net programs to provide health insurance for others, money freed up because of a single-payer plan could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance with large co-payments and deductibles, without any increase in total health care costs. This is not the time to impose on everyone in the country state health insurance programs that have failed multiple times. It is time to wake up from this insanity and enact single-payer health insurance for all.

The Massachussetts chapter of PNHP sent a letter from nearly 500 Massachusetts physicians to Sen. Edward Kennedy asking him not to push for a Massachusetts-style reform nationally. Hopefully these constituents will not just be ignored.





Maybe somebody, instead of listening to the corporate lobbyists, the Beltway will begin to listen to what the American people are actually saying, including support of single payer:

The polls suggest that the actual American people are way ahead of inside the beltway conventional wisdom as to what is politically acceptable:

Associated Press/Yahoo News Poll, Dec. 14-20, 2007 (.pdf, page 19): "Which would you prefer - the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance; or a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?" CURRENT=33%

UNIVERSAL=62%

NO OPINION=6%

Four years later the same question...

Associated Press/Yahoo News Poll, Dec. 14-20, 2007 (.pdf, page 15): Which comes closest to your view? "The United States should continue the current health insurance system in which most people get their health insurance from private employers, but

some people have no insurance" = 34% "The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers" = 65% Refused / Not Answered = 2%

Interestingly, when offered essentially the same universal program is offered alone without the comparison to the current system, but with the single payer name, the numbers from the same 2007 AP/Yahoo News poll was lower but still a majority:

"Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?" YES = 54%

NO = 44%

REFUSED/NOT ANSWERED = 2%

And just two weeks ago in a poll by CBS/NYT (.pdf, page 4):