Opinion

DON BRUNELL: To get a glimpse of future federal health care, look at Massachusetts

If you want a glimpse of what health care will look like under Obamacare, look at what is going on in Massachusetts.

In 2006, state lawmakers passed the Massachusetts Health Reform law. It was touted as a wave of the future and was the model for the new federal health reform law. But after a few short years, the law seems less like a wave and more like a sinking ship.

Like Obamacare, the Massachusetts law requires individuals and employers to purchase private health insurance or pay a fine. Like Obamacare, the law expands Medicaid coverage and provides taxpayer subsidies to help people buy insurance.

And like Obamacare, the law was supposed to increase access to health care and lower costs. So far, that hasn’t happened.

While 97 percent of Massachusetts residents now have health insurance, actually getting in to see a doctor is a challenge. ABC News reports that patients wait an average of 50 days to see a doctor in Boston, nearly double the next-longest wait time – 27 days in Philadelphia. Some patients are traveling outside the state to avoid the long waits.

The access problem won’t be resolved any time soon.

The Massachusetts Medical Society reports a critical shortage of family physicians and a severe shortage of internal medicine doctors in Massachusetts. A recent study by the Robert Wood Johnson Foundation found that 75 percent of noncrisis emergency room visits occurred because a regular physician was not available after hours and half of these visits occurred because patients couldn’t get a timely appointment with their doctor.

Dr. Lorraine M. Schratz, a pediatric cardiologist in Massachusetts, writes that more than half of all the doctors trained in Massachusetts are leaving the state, and one out of four doctors is considering a career change.

Rather than curb cost increases, post-reform health care costs in Massachusetts have risen faster than the rest of the nation.

Harvard physicians Rachel Nardin, David Himmelstein and Steffie Woolhandler say the reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009.

One reason is public subsidies. Science Daily reports that the largest increase in enrollment was through the Commonwealth Care program, which provides subsidies for families with incomes up to 300 percent of the federal poverty level – $66,000 for a family of four.

Another reason is that some people are gaming the system, buying insurance only when they need it, then dropping coverage. Charles D. Baker, a former executive with Harvard Pilgrim Health Care, says about 40 percent of the consumers who purchased insurance from his company on the open market kept the insurance fewer than five months. The medical bills they ran up far outpaced what they paid in premiums.

Recently, Massachusetts’ four major health insurance companies posted $150 million losses for the first quarter of 2010. They blamed most of those losses on the state’s decision to cap premium increases for the small group market, a category that covers 800,000 residents who are self-insured or employed by companies with 50 or fewer employees. The insurers had proposed rate increases from 8 to 32 percent for the small group market.

Now, some of those same insurers are warning that they will freeze or slash payments to doctors and hospitals already reeling from overcrowding and reduced Medicare and Medicaid reimbursements.

Why should we care? Because the Massachusetts health care system is the wave of the future. Obamacare has the same mandates, the same Medicare cuts, the same subsidies, the same price controls. Is there any reason to think the result won’t be the same?

It’s not often that elected officials have an opportunity to peer into the future and see how their policies will work out. Massachusetts has given us that look into the future, and federal officials have a chance to correct the mistakes before it’s too late.

It’s up to us to make sure they do.

Don Brunell is the president of the Association of Washington Business.

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