With ObamaCare based strongly on RomneyCare one would think someone in the media would take an in depth look at how it is working. That hasn’t happened.
Healthcare in MA was traditionally been provided by non-profit facilities with patients being able to choose where they want to receive care. The patient’s right to choose had been restored after the disastrous flirtation with managed care and capitation in 1980s and 1990s. This filtration produced numerous hospital closures, hospital consolidation, inpatient bed closures, replacement of professional staff with barely trained personnel and hospitals stays cut to the point of being dangerous (e.g. the notorious drive through deliveries). We still live with effects of this today as shown by the long waits in the ER for an inpatient bed.
What has changed under RomneyCare?
The Mandate: Under the mandate the number of people with health insurance has increased though MA numbers were quite high before RomneyCare.
One of the theories behind the mandate was that people if people had health insurance they would seek care from their primary care provider rather than in more expensive areas like the ER. That really hasn’t happened. In October a study was published in the prestigious New England Journal of Medicine (NEJM) comparing ER utilization in MA since Romney with that of other states. The study showed there was no difference between MA and other states.
Another problem with the mandate is the difference between health insurance and health care. They are 2 completely different things. The ex-insurance executives at the Commonwealth Connector , MA version of ObamaCare’s exchanges, have certified plans that are essentially junk insurance. These plans, designed for the traditionally low pay retail sector, have such high premiums, deductibles, and co-pays that the people who they cover will not be able to afford to use them. This is a win for the insurance industry that get premiums without providing care, the employer who can meet MA employer mandate without really proving insurance, and the politicians who can say everyone has health insurance.
Cost: The only negative fact about RomneyCare that has actually gone national is that costs have skyrocketed. To deal with this the state has decided has decided that we will go back to the failed 1990s strategies of capitation and managed care.
The people of MA do not have fond memories of these 2 things so they have been renamed. Capitation is now called “Global Payments”. Managed Care is now called Accountable Care Organizations. When this example of health care newspeak is brought up we are told it will be different this time as they will monitor “quality” of care and tweak the reimbursement formula.
The monitoring of “quality” has been given to the insurance industry that uses 30-50 indicators to define “quality” across the entire spectrum of health care. The idea that 30-50 indicators will ensure “quality” across the entire spectrum of healthcare is of course ludicrous. It actually has the opposite effect as providers are devoting a lot of resources to these limited indicators ignoring the thousands of other things that make up true quality health care.
The state, through its partners in the insurance industry, is also encouraging tiered health care plans. These plans restrict patient choice and set up a system where people who have more money or access to high quality insurance are able to go wherever they want while other must settle for something less.
Data is showing that RomneyCare’s insurance based approach may be one of things that is driving up provider administrative costs. A paper published in October in the NEJM looked at health care employment in MA after RomneyCare. Since RomneyCare waits to see providers have increased substantially. In response to this it was expected that the number of direct patient care providers (doctors, nurses) would have increased to meet this demand. The study showed the increase was very small. What increased dramatically was the number of administrative personnel (coders, billers, pre-approval staff). These are the people who take care of insurance companies rather than patients.
For-Profit Healthcare: Before RomneyCare for-profit hospitals were essentially non-existent in MA. Now Wall Street has decided that RomneyCare, the return to capitation and managed care has made it profitable to feed on the people of MA. Within a year a Wall Street hedge fund bought up large numbers of hospitals and formed a for-profit chains that is the second largest network in the state.
RomneyCare has had substantial negative impacts on the people of MA. In a state with the majority of insurers being non-profit and had a large number of people already insured before RomneyCare it is barely working. Why isn’t this covered nationally? RomneyCare is in the strange position of being important to both political parties. Mitt Romney will be the Republican candidate and it bears his name. ObamaCare is based on it and our part time governor’s full time job is co-chair of the Obama re-election campaign.
The things that are going on in MA should be followed nationally. ObamaCare is RomneyCare with some really bad stuff added like the “Cadillac Tax” designed to dump everyone into the individual market at the mercy of the insurance industry. The truth of the matter is you can’t provide universal healthcare through the commercial insurance market. MA is demonstrating this.