Grace-Marie Turner has a devastating piece in today’s Wall Street Journal about the failure of the health-reform plan that Mitt Romney installed while governor of Massachusetts. Describing health reform as “the defining political battle of our time,” Turner goes on to enumerate the ways in which RomneyCare has failed.
First, Turner identifies several key similarities between RomneyCare and ObamaCare:
Both have an individual mandate requiring most residents to have health insurance or pay a penalty. Most businesses are required to participate or pay a fine. Both rely on government-designed purchasing exchanges that also provide a platform to control private health insurance. Many of the uninsured are covered through Medicaid expansion and others receive subsidies for highly-prescriptive policies. And the apparatus requires a plethora of new government boards and agencies.
The emphasis in Massachusetts has been on subsidizing coverage for the uninsured, to the point that “[m]ore than half of the 408,000 newly insured residents pay nothing,” Turner writes.
Yet, 3 percent of Massachusetts residents remain uninsured — close to the proportion of uninsured Americans once you take out illegal immigrants, people who qualify for Medicaid but haven’t enrolled, and those who can afford health insurance but choose not to purchase it. That 3 percent, Turner writes, comprises about 140,000 people who “were either assessed a penalty or exempted from the individual mandate because the state deemed they couldn’t afford the premiums.”
Note the emphasized text. Even though more than 200,000 additional Massachusetts residents receive completely subsidized health insurance — “additional” because this group doesn’t include Medicaid recipients — there is still a group of people who can’t afford health insurance there. Assuming that subsidies begin in lower income brackets and move upward, it’s likely that the point of affordability has just shifted up the income scale.
Why would that happen? Perhaps because expensive mandates to cover certain services remain in place and health costs continue to rise, putting upward pressure on insurers:
One third of state residents polled by Harvard researchers in a study published in “Health Affairs” in 2008 said that their health costs had gone up as a result of the 2006 reforms. A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.
At this point, some readers will say the answer is a single-payer system. But as Massachusetts shows us, extending coverage is not the same thing as extending care.
The Bay State is also suffering from what the Massachusetts Medical Society calls a “critical shortage” of primary-care physicians. As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn’t been a corresponding increase in the number of doctors. As a result, many patients are insured in name only: They have health coverage but can’t find a doctor.
Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients, according to a 2009 physician work-force study conducted by the Massachusetts Medical Society. For new patients who do get an appointment with a primary-care doctor, the average waiting time is 44 days, the Medical Society found.
The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn’t actually require immediate treatment and could have been dealt with at a doctor’s office—if patients could have found one.
If the states are supposed to serve as policy laboratories, RomneyCare is an experiment we should never replicate on the national level. And as it happens, there is an actual conservative health reform experiment conducted by another potential 2012 hopeful:
One of the challengers Mr. Romney could face in 2012 is Gov. Mitch Daniels of Indiana. Mr. Daniels went in a very different direction in tackling the problem of the uninsured. He created a program targeted to lower-income uninsured people who weren’t eligible for Medicaid or employer insurance. Mr. Daniels’s Healthy Indiana program has a fixed budget and relies on shared responsibility between the newly insured and the government in managing health spending.
Democrats may (or may not) pass a health bill as soon as this weekend, but health care will remain an important topic through the 2012 elections because the new programs won’t have kicked in by then, only the new taxes. In theory, a future president and future Congress could still act to change to elements of the reform — particularly if the candidates for those offices run explicitly on a platform of doing so.
None of which bodes well for Mitt Romney.