The Operation Was A Success But The Patient Died

It's been a while since we discussed health care reform so let's do it once more again tonight. The current health care bills being formulated in both parts of Congress are said to be analogous to the sweeping health care reform that the state of Massachusetts instituted several years ago. How is that going? According to the Briefing section in the August 28 edition of The Week magazine (www.theweek.com), it seems to be consistent with the old joke: "The operation was a success but the patient died.":

Success - Massachusetts now enjoys the lowest percentage of uninsured citizens in the country: 2.6% of Massachusetts citizens are uninsured vs. 15% nationwide.

The Patient Died - while Massachusetts got the percentage of uninsured down, there have been a few problems with the entire effort (according to The Week article):

• The budget for the program ran out of money, becoming a major factor in the state's recent $9 billion overall budget shortfall.
• Closing the budget shortfall required the state to cut funding in other areas including education and other areas.
• Overall, medical costs and spending did not decrease as planned.
• To make up for the budget shortfall going forward, the state wants to change some of the compensation programs it uses to pay doctors, i.e. change the rules after the game started, which has now ticked off many medical groups who initially supported the reform effort.
• Massachusetts assumed fewer people would go to emergency rooms for medical treatment once they had insurance and thus, they reduced funding for hospital emergency rooms in order to pay for the entire reform budget.. This has turned out to be an incorrect assumption since emergency room visits has actually increased since the reform program took effect, resulting in a shortage of doctors.
• Earlier this year the board in charge of the health insurance fund voted to save budget by slowing down enrollment, i.e. stop people from enrolling in the program even though the program was established to get people enrolled. Go figure that one out!
• The board also eliminated dental coverage (I think that this is called "rationing" by most intelligent people), reduced payments to hospitals, and increased the cigarette tax by a $1 a pack.
• In a June survey, only 26% of the state's residents think the health care reform program in the state was a success while 37% called it a failure. the remaining respondents were not sure. Further, only 10% feel that the quality of health care has gotten better as a result of the reform.
• The article concludes by pointing out that all of the underlying fundamentals for reform in Massachusetts were better than average: the state had a relatively higher number of residents insured before reform, the economy was in real good shape at the time the reform was implemented, and the state had above average personal income averages.

So let's see: the percentage of uninsured went down (hurrah!) but hospitals lost funding, doctors got ticked off when the state changed the rules, the program overrun costs caused other state services to be cut, taxes were increased to fund the program, emergency room visits unexpectedly went up, doctor shortages have cropped up in hospitals because of funding cuts, coverage went down (loss of dental coverage), medical costs were not curtailed, and many more state residents think the program is a failure than think it was a success despite the fact that the Massachusetts' economy was closer to optimal for success than the rest of the country as a whole. Certainly looks like the patient died.

And now the political class at the national level comes up with a 1900+ page document that will do similar things on a national level that Massachusetts failed miserably with at the state level. Do we really think they have any chance of pulling this off from inside the Beltway when they have failed so miserably at doing anything else half way efficient and cost effective?

The bottom line: in both Massachusetts and in DC, no one has done a root cause analysis and in-depth quantification of the underlying drivers of the problem. No one understands the complexity and interdependencies of the entire system and thus, anything they propose will undoubtedly cause unintended, and usually costly, consequences. That is where Step 28 in "Love My Country, Loathe My Government" is the right prescription. The political class needs to start over, appoint a panel of expert Americans from all walks of the medical industry, and let them hammer out a fair, logical and workable health care reform plan much like FDR did with the Manhattan Project, JFK did with the Apollo space program and Reagan did with his public education reform commission. Take the political class out of the process, they contribute nothing. We do not need another successful corpse from Washington.