Articles are from NCPA (National Center for Policy Analysis)

Maine

MAINE FINDS A HEALTH CARE FIX ELUSIVE

Maine's legislators have tried for decades to fix its health care system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded.  Indeed, many overhauls to the system have done little more than squeeze a balloon -- solving one problem while worsening another, says the New York Times.

To conservatives, Maine proves that government efforts to strictly regulate the nation's health insurance market are doomed.  Many of the reform proposals circulating on Capitol Hill have already been tried in Maine:

• A state-sponsored insurance plan has been capped at fewer than 9,000 because of financing problems, and the most common choice of those buying new plans in the state requires them to spend at least $15,000 a year before the insurer pays anything -- leading many to avoid important medical visits.
• Maine is one of 17 states that limits how much insurers can charge people for being older, and it does not allow exclusions for previous illnesses -- both policies that are part of national reform proposals.
• One result is that premiums for younger people are relatively high; although national proposals would require that nearly everyone get coverage or pay a penalty, Maine's Legislature rejected such a mandate so many young people do not or cannot buy insurance -- further skewing the insured pool to sicker and older people and making premiums that much higher.

Another change Maine has tried is to expand its eligibility rules for Medicaid, the government program for the poor.  Nearly a quarter of the state's population participates in the poverty program.  Proposals on Capitol Hill would require similar expansions across the country.

But Maine's poor are among the sickest in the nation, and its Medicaid benefits are relatively generous.  Only Alaska spends more per adult Medicaid beneficiary.  Part of the reason may be that, because premiums in the private insurance market are so high, many go without insurance for years before qualifying for Medicaid, says the Times.

Source: Gardiner Harris, "Maine Finds a Health Care Fix Elusive," New York Times, November 11, 2009.

For text:
http://www.nytimes.com/2009/11/11/health/policy/11maine.html
 
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Massachusetts

HEALTH "REFORM" GETS A FAILING GRADE

As the health care reform debate nears a conclusion, it would be prudent to examine the lessons learned from the recent experience with reform in Massachusetts.  There, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but -- despite initial predictions -- increased total spending, says Jeffrey S. Flier, dean of the Harvard University Medical School.

A "Special Commission on the Health Care Payment System" recently declared that the Massachusetts health care payment system must be changed over the next five years, most likely to one involving "capitated" payments instead of the traditional fee-for-service system, explains Flier: 

• Capitation means that newly created organizations of physicians and other health care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets.
• Unfortunately, the details of this massive change -- necessitated by skyrocketing costs and a desire to improve quality -- are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.
• Yet it's entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire.
• Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.

Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task.  It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation, says Flier.

So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America.  According to Flier, he's met many people for whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead, says Flier.

Source: Jeffrey S. Flier, "Health 'Reform' Gets a Failing Grade," Wall Street Journal, November 17, 2009.

For text:
http://online.wsj.com/article/SB10001424052748704431804574539581994054014.html
 
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