Friday, April 07, 2006

Massachusetts Health Reform: Medical Student Perspective

We are the only industrialized nation in the world that does not provide health care for its citizens – yet we are the richest and most powerful.

Lawmakers in Mass. are taking the lead in getting our country up to speed with the rest of the industrialized world – and it’s about time. The goal: get the state’s uninsured covered.

- Get the story
- Official Mass. Summary and Fact Sheet

Before I get to my thoughts about what Mass. is doing, let me share my own experience. The medical school I attend used to offer an optional health insurance plan at a reasonable cost with good coverage. The result: only the students needing medical treatment took the insurance – healthy students didn’t see the need (I don’t blame them, I’d do the same). After a few years, the insurer was loosing money and pulled out. Then they required some sort of health insurance – so healthy students like me got the most basic, emergency-only coverage; leaving the students who needed better coverage to pay through the nose for good coverage.

This past year, they required all students who were not covered under their parents’ insurance to purchase comprehensive coverage. A copy of the parents’ benefits plan and card were required to waive the school coverage. The coverage is good, but costs a little over $3,000 a year! And it doesn’t cover dental and optical! You would think that a medical school that supposedly is dedicated to providing coverage to all would start with their students (I will blog about Medical School Hypocrisy soon).

My general impression with the Mass. health plan is that it’s a step in the right direction.

What I Like…
It’s the closest thing to universal coverage that we’ve come up with – though it is still a ways away from being called a victory. Everyone deserves to be healthy and deserves access to healthcare – but somebody’s gotta pay for it. This law forces everybody to chip in.

It’s a great compromise between liberal ideas of “government knows best” with conservative ideas of “privatization”. The government tells you that you need health insurance but leaves it up to private insurers to provide it for you.

The law recognizes the need to exempt those who the government deems not able to pay insurance premiums and gives them a free ride – at or below 100% poverty level (I think it’s at about $13,000 a year for 2 person household). It also subsidizes premiums for those between 100%and 300% poverty level.

The law forces companies with more than 10 employees to chip in to the system. Until now, if a company wanted to cut costs it usually resorted to cutting health insurance (or just never offered it to begin with). This was a huge competitive advantage for these companies – which means they are kinda cheating. The law requires companies not offering health insurance to pay about $300 per year per full time employee. It is not nearly enough to make up for the difference, though – but it might be enough to convince employers to start offering health insurance.

What I Do Not Like…
I don’t like insurance companies very much (I will blog about this another time). I read a report somewhere that insurance companies add an extra 30% to the medical costs due to overhead and administrative costs. Compare that to only 3% for government-run Medicare.

I know I know - the government does not make the best administrator – but at least they have a handle on their costs – at least when it comes to Medicare.

Health insurance is still darn expensive. The bill predicts that insurance premiums will be lowered by 25% or so, but – as anybody who has walked into an expensive store during a “sale” can profess – 25% off an expensive item is makes it only slightly less expensive. Also, 300% above the poverty level is only about $35,000 a year for 2 people. Last time I checked, that was barely enough to live on after taxes – especially in an area like Boston.

What about quality of service? You get what you pay for – low cost insurance is usually junk – you end up getting stuck with medical bills anyway because they don’t cover much or they have such high co-pays. So what’s the point of even having such insurance if you’re going to pay for most of your medical bill anyway?

At first it looked like a great idea. But as I kept learning more and more, it seemed like Mass. was throwing a huge bone to the insurance companies. I suppose, though, that it was the only way they could simulate universal health care without facing huge opposition from insurance companies and conservatives.

Maybe one day we Americans will unite to do what we do best – come up with genius ideas for problems - and find a way to cover everyone in a way that benefits all.


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