Wednesday, February 18, 2009

Massachusetts, Universal coverage -Rats! Single-Payer Foiled Again!

From The Health Care Blog, February 18, 2009

Massachusetts doctors say single-payer or bust


Massachusetts members of the Physicians for a National Health Program released a report today faulting the state's experiment with health reform for failing to achieve universal coverage, being too expensive and draining funds away from safety-net providers.

The doctors' punch line is that the reform has given private insurance companies more business and power without eliminating vast administrative waste. In fact, it says, the "Connector" in charge of administering the reform adds about 5 percent more in administrative expenses.

In summary, nothing less than single-payer national health reform will work, according to authors Drs. Rachel Nardin, David Himmelstein and Steffie Woolhandler, all professors at Harvard Medical School.

The report criticizes the Urban Institute's report that found only 2.6 percent of Massachusetts' residents were uninsured in mid-2008 because it failed to sufficiently reach non-English speakers in its survey.

The insurance products despite being skimpy, high-deductible plans, are not affordable, making the mandate that individuals buy them regressive, the report says. And moreover, it says, peoples' experiences have shown that insurance does not guarantee access to care. The Boston Globe chronicled the long wait for primary care last September.

A final criticism the 19-page report offers is that the reform is financially unsustainable, as it does "nothing about a major driver of high health care costs, the overuse of high-technology care such as CT scanners and surgeries, and the underdevelopment of primary care."

Last winter, Himmelstein spoke about health reform to students at Johns Hopkins School of Public Health. I asked him if single-payer advocates would work against any national reform effort that wasn't single-payer, as the single-payer camp did in California.

Himmelstein said that if the reform plan looked like the Massachusett's reform he probably would prefer the status quo. He believes the reform has made most vulnerable patients in Massachusetts worse off.

It looks like health reform is going to be a battle on the Left and Right.


Let me suggest that the headline is a little misleading (though it follows the press release that PNHP put out.)

"Massachusetts Doctors" are not calling for Single-Payer.

A small group of Massacusetts doctors who belong to Physicians for a National Health Plan (PNHP) are calling for single-payer.

PNHP has been dedicated to pushing for single-payer for years. This is not news.
Yet the way the press release (and this post) presents it, it seems that things have gotten so bad under reform, that physicians are rising up, statewide, to call for single-payer.

As the Boston Globe has made clear, a major problem that is making Mass healthcare so expensive is NOT INSURERS but hospitals (specifically Partners) insisting on charging 30% more than other hospitals simply because they are a brand name. And because the public sees these hospitals as a "brand" INSURERS HAVE BEEN POWERLESS TO DO ANYTHING ABOUT IT.

(Frank Pasquale wrote a very good guest-post about this on HealthBeat (He's a visiting law professor at Yale who specializes in healthlaw, and he has his facts straight. Maybe you could cross-post, just to balance things out?)

Let me be clear: I am not opposed to single-payer as a concept. But at this point in time it is very, very clear that it is Not Going to Happen. The majority of the public does not want to give up the insurance it has for Single-Payer.

So, at this point, the single-payer advocates are simply dividing progressive health care reformers at a time when we need to be united against the conservative opposition.

Giving the single-payers a platform on THCB by spreading the idea that Insurers are the problem making Mass care so expensive and that Mass Doctors are calling for single-payer seems to me--in my humble opinion--a mistake.

Mass health care is the most expensive care on earth because there are more hospital beds and specialists per capita than in any other place in the U.S. Jack Wennberg's Dartmouth research has made that clear (As has THCB). This is why per-capita health care spending is so high in Massachusetts--it is supply-driven. This has nothing to do with insurers.

Posted by: maggiemahar | Feb 18, 2009 12:32:14 PM

Harvard professors Nardin, Woolhandler and Himmelstein’s remorse about the U.S. not following the Canadian single payer model reminds me of the Robert Browning story of the “Pied Piper of Hamelin City.”

Great rats, small rats, lean rats, brawny rats,
Brown rats, black rats, gray rats, tawny rats,
Grave old plodders, gay young friskers,
Fathers, mothers, uncles, cousins,
Cocking tails and pricking whiskers,
Families by tens and dozens.
Brothers, sisters, brothers, wives –
Followed the Piper for their lives.
Only in the case of U.S. health reform,

It’s single payer and multiple payer rats,
blue and red state rats,
Policy and practice rats,
Left-leaning and right-leaning rats,
liberal and conservative and connector rats,
private and government payer rats,
hospital and outpatient rats,
primary care and specialty rats,
Who is to be the Piper?
Who is to call the Tune?
Who will run the health care Saloon?
I thought Massachusetts had the Pilot Balloon,
But say single-payer loons, Massachusetts is not even Canadian Picayune.
When, oh when! will we have a post-partisan, one-for-one, all-for-one, completely level , free playing field for all in this individualistic nation? Some of us non-utopian rat hopes never.

Moral: Rats! Single Payer foiled again !

1 comment:

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