Part 1: RomneyCare
Governor Peter Shumlin has repeatedly noted that when it comes to health care reform, government has “gotten it wrong every single time.” One reason, he has said for this is that other plans, including our own Catamount failure, did not place a focus on cost control. And, this time, we’re going to put “really smart people” in charge. But, how is what we are proposing here in Vermont really all that different at heart than what other states have tried and failed to do? If the best way to learn is from other people’s mistakes, it is worth taking a look at the goals and realities of other state healthcare reform efforts and the… must we presume “dimwits”?… who ran them.
The Massachusetts Health Care Reform Effort
In April 2006, Governor Mitt Romney of Massachusetts proudly declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance and the cost of health care will be reduced.” Contrary to what Governor Shumlin might have us believe, these goals — universal coverage wile simultaneously reducing health-care costs — sound awfully similar to his own pronouncement after passage of H.202: Vermont will be a place, “where health care will be a right and not a privilege… and where we’ll have an affordable system that contains costs.”
One specific problem Massachusetts set out to fix was the high cost of treating uninsured patients through the ER. If those folks only had insurance, so the logic went, they would use the more cost effective route of seeing a primary care physician.
So, how did An Act Providing Access to Affordable, Quality Accountable Health Care, otherwise known as “RomneyCare,” deliver on its promises?
From a cost perspective, “An analysis from the Massachusetts Taxpayers Foundation found that state spending on health care reform grew from $1.04 billion in 2006 to about $1.75 billion in 2010. Over the next 10 years, RomneyCare will likely cost $2 billion more than predicted.”
But that is just the tax component of RomneyCare. The insurance premiums people have to pay have skyrocketed. “The average employer-sponsored family plan costs nearly $14,000 – higher than anywhere else in the nation.” (National Review)
A 2010 study published in the Forum for Health Economics & Policy found that health insurance premiums in Massachusetts were increasing at a rate 3.7% slower than the national average prior to the implementation of RomneyCare. Post-overhaul, they’re increasing 5.8% faster. (Forbes)
From a coverage perspective, from the estimated 372,000 to 540,000 Bay Staters who didn’t have health insurance before RomneyCare, about 100,000 still don’t. And for those that now do, it doesn’t mean they’re getting care.
A recent poll by the Massachussetts Medical Society discovered that, “The average wait ranged from 24 days for an appointment with a pediatrician to 48 days to see an internist. The wait for an internist was actually down slightly, from 53 days in a similar 2010 survey, but the waits for family doctors, gastroenterologists, orthopedists, and ob/gyns increased.”
That’s if you can get a doctor. Again, according to the Massachussetts Medical Society, “Access to primary care physicians is becoming more restricted, as more than half of primary care practices – 51% of internists and 53% of family physicians – are not accepting new patients. These figures remain close to those of last year’s survey which showed 49% of internists and 54% of family physicians not accepting new patients.”
Why is this? Because the passage of the law increased the supply of patients, but didn’t increase the supply of doctors. This is a critical point to understand: government cannot create a single doctor or nurse. The only thing that can do that is an individual operating in a free market with free will, choosing to invest the time and resources necessary to learn how to heal. If government takes the incentives to do that away, there is no health care.
As for reducing those expensive ER visits, “Emergency room visits climbed 9%–or 3 million visits–between 2004 and 2008. The bill for uncompensated care has exceeded $400 million. (Forbes)
All of theses failures, so divorced from the rhetoric that launched the policies, must have occurred because “really smart people” were not involved in RomneyCare’s noble goal of increasing coverage while reducing costs work, right?
Of course, Romney himself has joint Juris Doctor/Master of Business Administration degrees from Harvard Law School and Harvard Business School. (Shumlin’s bio says only that he graduated from Wesleyan University in 1979.) The architect behind Romney Care is MIT Economics Professor Jonathan Gruber. Gruber earned a Ph.D. in Economics from Harvard University in 1992, and is also the brains behind Obamacare. Glen Shore, who was appointed Executive Director of the of the Commonwealth Health Insurance Connector Authority, an independent authority established by RomneyCare to help promote access to affordable health insurance, has a law degree from Harvard Law School and graduated from Yale University with a B.A. in history…. You get the picture.
RomneyCare didn’t fail because it didn’t focus on cost control. It did. It didn’t fail because smart people weren’t involved. They were. It failed because the inevitably political process of government is the wrong instrument to deliver health care, and, so long as government insists on playing a leading role in delivering health care it will fail every time.
This is the first article in a series examining health care reform failures in Massachusetts, Tennessee, Maine and Vermont.