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April 05, 2006

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penxv

The patients will be treated like cars going through an assembly line. The insurance mandate will effectively increase the demand for medical care while the supply will remain unchanged for the time being. The result will be less time with the doctor (a decrease in the quality of care), and a longer waiting period to see the doctors. Plus... many decisions will be made by the insurance companies rather than the doctors and patients.

The net shortterm effects might be positive. In the long run, care will diminish in quality and in availability.

G. Hinson, MD

As a Massachusetts physician, I am a little torn with the legislation passed yesterday mandating that everyone buys health insurance. I should be happy that I will no longer have any uninsured patients, right? I should be happy that our hospital will see a decrease in their free care write offs. Something smells funny about it.

This plan is beautiful politic. It is bipartisan and was almost unanimously passed by the legislature. It is not just a promise to fix things, it's an actual attempt to do it. It cannot be coincidental that it happened earlier enough for Gov. Romney's presidential campaign, and yet late enough that if the plan fails miserably, it will hurt his chances. It promises health insurance for everyone!

There are some serious holes here. An op-ed piece in today's Boston Globe likened the plan to breaking ground on a new mansion, without knowing for sure you can afford the mortgage. The plan is to create a new state agency to run things, and acknowledges that costs will rise to $1 billion by the third year, and yet only guarantees $125 million in new state funding. Hello?

Dig a little deeper and you will see that this plan will make it easier for employers to NOT cover their employees. All businesses with 11 or more employees will have to provide health insurance for their employees or pay a penalty fee of $295/year. This fee is meant to go into the pool to cover everyone who needs state-subsidized insurance (presumably by extending Medicaid). Given that health insurance here is extremely expensive, averaging about $400/month per employee, and $800/month per family, this employer is forced into a tough decision. Maybe she already pays for health insurance. Now she can drop the benefit, give the employee a $1,000 bonus, pay the minuscule penalty fee, save $8,305 per year per employee, and know that the employee will STILL be covered by the state. Given that the $295 fee does not come CLOSE to covering the costs of that coverage, I wonder, as a resident of the state, who's pocket the state plans on picking to get the money to guarantee this coverage!

So why did the lawmakers come up with such a plan? Altruism? Sure. Presidential aspirations? Absolutely. Let's also follow the money!

According to The Globe, lobbyists took in $7.5 million for their efforts surrounding this legislation. BCBS paid $294K, Partners (the highly profitable organization that runs Mass General and Brigham and Womens) paid $206K, Massachusetts Association of Health Plans paid $208K, Massachusetts Hospital Association paid $263K, Eli Lilly paid $299K. Let's look at who wins and who loses and you decide if this plan is going to succeed.

1. The poor, uninsured will absolutely benefit from this plan. They will now qualify for Medicaid and have health insurance that is provided by the state without so much as a deductible.

2. If you make more than the poverty level, e.g., more than $48K for a family of 3, and you do not have health insurance, you will not be forced to purchase health insurance by July, 2007 or else face penalties of up to half the cost of a policy on your taxes. If you are lucky enough to have "good health insurance" though your employer, there will now be a chance that your employer will opt to pay the penalty instead and make you provide your own health insurance, most likely via a state-run plan that offers less coverage.

3. If you are upper, middle class, this probably does not effect you much. There is a chance you will see modest decrease in your health insurance premiums.

4. If you are a small hospital, struggling with a balance sheet weighed down by free care, you benefit greatly.

5. If you are a large, Boston hospital, with an even larger free care burden, you stand to benefit tremendously. The bill is expected to add $270 million in new Medicaid reimbursement money over the next three years. The Partners hospitals are expected to get approximately 15 percent of that money, more revenue for an organization that is already enormously successful.

6. If you are a small employer providing health insurance, you are unaffected. If you do not provide health insurance, you will now see a modest penalty of $295/employee/year. (This was originally going to be $800, but the Small Business lobby threatened to hold up the bill unless this was changed.)

7. If you are a small group or solo physician, on the one hand you benefit by seeing fewer people who cannot pay and by increased revenue from Medicaid, but on the other, you will be seeing a much higher percentage of Medicaid patients. And this bill includes as-yet-to-be-defined pay-for-performance requirements! I like this language from an article about the measure in the Boston Globe--"In addition to improving quality, hospitals and doctors must show they are reducing racial and ethnic disparities in the delivery of healthcare and outcomes for patients." How much time away from patient care am I going to have to spend to prove this?

8. If you are an executive with a health insurance company, you are making phone calls to the local Bentley dealer, and dancing to imaginary music when the doors of your office are closed and no one is looking!

penxv

Insurance companies have almost become an arm of the government.

The government doesn't mandate that we purchase a home, a car, milk, butter, or cheese, but it mandates that its citizens must purchase insurance?! (There is definitely some money changing hands).


The way that the lawmakers have declared ownership over the people of Massachusetts is pretty shameless and obvious.

Ron Norton

Insurance is not the solution, it is part of the problem. The HMOs have ruined our health care delivery system. These useless policies mandated by law are expensive, have high deductibles, and cover virtually nothing. The "personal mandate" is fascism, it will reap porfits for the greedy insurers and wreak havoc on middle class budgets. The arrogance of this law is astounding! It is time we took back the government!

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