Doctors criticize Massachusetts health law
By Lisa Wangsness
Boston Globe
Healthcare
Thursday, February 18, 2009
WASHINGTON — A trio of Boston doctors says the 2006 Massachusetts healthcare law is a poor model for a national system because it leaves too many people without affordable care.
In an analysis issued earlier today and an accompanying letter signed by nearly 500 Bay State physicians, they urged Senator Edward M. Kennedy to push for a Medicare-for-all style national healthcare system, something Congressional leaders and the White House have rejected as politically unworkable as they consider a major overhaul to the healthcare system this year.
“Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all,” the letter said.
The Massachusetts healthcare law essentially builds on the existing health insurance system, where most people obtain coverage through their employers. It requires virtually all people to buy insurance and provides limited assistance to those who cannot afford it. President Obama and Senate Finance Committee Chairman Max Baucus have endorsed aspects of the plan, making it likely to influence any effort to overhaul the national system.
The doctors’ analysis — written by Rachel Nardin, a neurologist and an assistant professor at Harvard Medical School, and Steffie Woolhandler and David Himmelstein, both primary care doctors and associate professors at Harvard Medical School — questions the quality of data showing that all but 2.6 percent of Massachusetts residents have insurance, arguing the number is probably 5 percent or more.
The doctors also say that the new insurance available to lower middle class people imposes unaffordale out-of-pocket costs, particularly on the chronically ill. And they argue that because the new law is more expensive than anticipated, the state has prematurely cut funding for “safety net” providers who help the poor free of charge, leaving them without a last resort.
“Despite having health insurance, many Massachusetts residents cannot afford care,” Nardin said at a press conference in Washington earlier today. She cited the example of a young diabetic from the Boston area whose costs went from nothing under the old “free care” system to $340 per month under the new law, consuming one-quarter of her take-home pay.
Asked how Congress and the White House might avoid Massachusetts’ mistakes to create a better national system, Woolhandler and Nardin said the main lesson was that a Medicare-for-all style system is the only way to achieve universal health reform.
Supporters of the Massachusetts system dismissed the doctors’ analysis as driven by ideology more than by facts.
“They let the perfect be the enemy of the good,” said MIT economist Jonathan Gruber, a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law.
Gruber noted that the Connector has capped out-of-pocket costs and premiums for low-income people, ensuring that someone making less than three times the poverty level — about $32,000 for a single person — will pay no more than around 10 percent of their income each year. He acknowledged, however, that those who earn between three and five times the poverty level may have a harder time finding affordable insurance.
Jon Kingsdale, executive director of the Connector, added that out-of-pocket costs for people who earn two to three times the poverty rate are similar to what most people in that income range pay for insurance through their employer.
“Their criticism that we substantially raised cost-sharing for most of the people we’ve helped… is absolutely untrue,” Kingsdale said.
He also noted that while some low-income Boston and Cambridge residents could obtain comprehensive care free of charge before the law passed, most people living outside the metropolitan area then lacked access to drug benefits and broad range of specialist care. Insurance provides access to comprehensive care, he said.
Data on uninsurance is not perfect, he added, but that surveyors went to great lengths to be accurate.
Kingsdale also said the doctors’ analysis did not accurately portray the cost of subsidized insurance for low-income people; Kingsdale said the cost in the 2008 fiscal year was $800 million, not more than $1 billion.