New research in the Archives of Ophthalmology warns hospitals to prepare for an overload of emergency department (ED) visits after health reform kicks in. Florida hospital EDs already saw patients eligible for Medicaid jump 6 percent between 2005 and 2009, well before millions of Americans are expected to gain health insurance in 2014, reported The Tampa Tribune.
Meanwhile, approximately 68 percent of emergency physicians in Massachusetts saw an uptick in visits due to the state’s universal health plan, the model for national health reform, according to a 2009 survey, noted The News-Press.
While Romneycare is one large driver of rising costs in the Bay State, an equally large driver has been the 1993 merger between two eminent Harvard-affiliated hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital. With the two most prestigious hospitals in the state locking arms, insurers were hosed. The new hospital monolith, Partners HealthCare, could deny access to the beneficiaries of any insurer who dared not accept whatever they wanted to charge. After all, who would want to be on an insurance plan that didn’t have access to the two most prestigious hospitals in Boston?
In 2008, the Boston Globe ran an important exposé on the “handshake that made healthcare history”: Partners’ secret agreement in 2000 with Blue Cross Blue Shield of Massachusetts, in which Blue Cross would give Partners more money, in exchange for Partners’ promise that they would demand the same rate increases from everyone else. The growth rate of individual insurance premiums in the state doubled.
For those with short memories, let’s review the bidding. The argument for the Massachusetts health plan was: Instead of providing free care to the uninsured at emergency rooms and safety-net clinics let’s insure them so that they can get more accessible, less costly care from regular physicians. The result: traffic to hospital emergency rooms in Massachusetts is higher than ever and now this:
The report, published in the Archives of Internal Medicine, found that the number of patients treated at the health centers rose 31 percent from 2005 to 2009. During the same period, the percent of uninsured patients at the clinics declined from 35.5 percent to about 20 percent.
Economic textbooks stress the role of prices in allocating resources. Yet the reality is that we pay for almost all of the goods and services we buy with both time and money. The size of the time price, versus the money price, varies a lot from good to good, market to market and even by the hour of the day.
Most of us accept this reality as a normal part of life without experiencing any emotional stress or moral outrage. I’ve never heard anyone say that paying with time is more moral or just or fair than paying with cash. Certainly no one ever argues that paying with time rather than money is more efficient.
Except in health care. As loyal readers of my blog discovered long ago, health policy analysis attracts an unusual breed of thinker:
They almost universally believe that if health care has to be rationed, it’s always better to ration by waiting instead of rationing by price — even when the service is something almost everyone could easily afford (e.g., a doctor’s visit).
They believe that paying for care with time, rather than money is more efficient, even though the most rudimentary economic analysis shows that belief is wrong.
And they believe that people who pay for care with time are “insured” while people who pay with money are “uninsured” — even if the same people end up getting the same care under either system.
[Note to self: Does health policy analysis attract people with peculiar personality disorders? Or do they just get crazy after they become immersed in the field?]
“I ain’t saying you treated me unkind…. You just kinda wasted my precious time.”
TheWall Street Journal’s Joseph Rago recently wrote an indictment of the Massachusetts health reform, generally viewed as the model for recently enacted federal health reform. One of the criticisms he notes is that people in Massachusetts who do not have employer-based benefits can wait until after they have become sick to apply for health insurance via the Commonwealth Connector. This is because the fine levied by the state for not having health insurance is rather trivial.
Many fear that this will also happen under ObamaCare. As of 2016, unless a person has qualifying coverage from his employer or through an exchange, the IRS will levy a penalty of the greater of $695 or 2.5% of a taxpayer’s household income. On its own, this would hardly seem enough to dissuade people from waiting until after they have become sick to buy increasingly expensive health insurance. Furthermore, people with incomes under 133 percent of the Federal Poverty Line (FPL) will now be eligible for Medicaid, which means they will be exempted from the penalty, as will anyone whose health insurance costs over 8 percent of his gross income.
European regulators: There is no evidence of any beneficial health effects from antioxidants. OK, but is that a reason to bar the word “antioxidant” from labels as prima facie health claims?
The number of people who appear to be gaming the state’s health insurance system by purchasing coverage only when they are sick quadrupled from 2006 to 2008, according to a long-awaited report released yesterday from the Massachusetts Division of Insurance… The number of people engaging in this phenomenon — dumping their coverage within six months — jumped from 3,508 in 2006, when the law was passed, to 17,177 in 2008, the most recent year for which data are available.
The Massachusetts Connector has a $40 million administrative budget that employs 45 people earning an average $100,000 salary. In contrast, the Utah Exchange has just two employees and a budget of $600,000. The authors write, “Fewer than 1,500 small business employees receive coverage through the Connector. In Utah, with a far smaller population, about 55,000 small business employees have purchased health insurance through the Exchange. It offers 66 plans from a number of carriers, including the largest ones in the state.”
Published twice per week, Health Alerts are exclusive, in-depth analyses of health care policy by John Goodman. Subscribe via RSS or enter your email address in the box above.
