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The Massachusetts reforms are working

As Paul Krugman notes, the Massachusetts reforms are working pretty well. Not perfectly, and it's a good thing indeed that the plans Congress is considering go quite a bit further than anything attempted by Massachusetts, but the Bay State has shown that the basic combination of a mandate, subsidies and an exchange can work to radically increase coverage.

Krugman also mentions that a recent poll found that 75 percent of the state's physicians supported the reforms and wanted to see them preserved. This reminds me of a conversation I recently had with a Boston-based doctor. I asked how she liked the reforms, and she shook her head. They just don't work that well, she sighed. I figured she'd go on to criticize the payment rates or the flood of new patients or the bureaucrats telling her what to do. Instead, she explained that she came over from England, and compared to the British health-care system, our efforts to care for everyone and create a coherent system of care where really quite crude.

By Ezra Klein  |  October 26, 2009; 10:01 AM ET
 
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Comments

"I figured she'd go on to criticize the payment rates or the flood of new patients or the bureaucrats telling her what to do."

Huh? The bill provided coverage for the uninsured. That's it. There's no reform (yet) on payment, physician oversight, etc. Just coverage. So what, exectly, would a doctor object to? Flood of new patients? Huh? That's their business. If they don't want new patients, the response is pretty easy "Our practice is closed to new patients." That's a common phrase in Massachusetts right now.

Posted by: wisewon | October 26, 2009 10:19 AM | Report abuse

Harvard cooks it's polls. Ask the towns (everyoneof them by the way)that have laidoff a bunch of firefiters, policemen and teachers how they like it. And ask if people would rather have them working then paying for this masshealth junk. Harvard won't do a poll on that will they. I'd bet a million dollars them only polled hospitals that already agree'd with them.

Posted by: obrier2 | October 26, 2009 10:26 AM | Report abuse

I wonder what your doctor friend thinks about this:

http://www.ama-assn.org/amednews/2009/06/01/bisb0601.htm#


This is where we need to go and not just for Mass. You want cost control, here's how to get it. YOu want affordability, here's how to get it.

Posted by: visionbrkr | October 26, 2009 10:30 AM | Report abuse

The only good thing about passing the individual mandate with no cost control is it's going to light a fire under a lot of smart people to figure out a better way.
I expect some states will go for single payer. Some may go for Wyden-Bennett. Maybe someone will go for NHS.

I'm surprised you think Massachusetts doesn't go as far as Congressional plans. If you look back to that chart Nicholas Beaudrot made, subsides are far more generous in Massachusetts--and people there still complain about affordability.

Posted by: bmull | October 26, 2009 10:35 AM | Report abuse

*So what, exectly, would a doctor object to? Flood of new patients?*

Ezra has likely been surrounded by a bunch of people willing to offer him anti-HCR talking points, and one of those talking points I've noticed is, "America can't actually handle treating all the people who are going to ask for health care if they have coverage." No, it doesn't make sense, but you hear it a lot.

I'm really not sure how the two-pronged attack on HCR of "Americans are too stupid and unhealthy to deserve health coverage" and "doctors are too stupid and lazy to handle having more patients" is really a successful line of reasoning from opponents, but that's what they're saying.

Posted by: constans | October 26, 2009 10:44 AM | Report abuse

It's not surprising that providers in Massachusetts are happy with the insurance mandate given that its major objective was to see that they got paid. It's one of the most provider saturated markets in the US and also one of the highest cost. How does that fit with the market driven, free market theory of health care provision?

Providers and well-meaning voters aside, how do those who were ostensibly helped by the new law feel about it? I saw some not so rosy reports about that a few weeks ago: less than 40% of those who supposedly benefitted from the new system liked it. The number of insured residents who had postponed treatment due to financial considerations was quite troubling -- as were the number who had incurred medical debt under the program.

"The uninsured" are not the problem that we need to solve; they are a symptom of our unsustainable health care model. Unlike every other industrialized country, the richest country in the world cannot ensure that every citizen receives medical treatment when he needs it without bankrupting himself and/or his country. *That* is the problem.

By framing the problem as "the uninsured", legislators and policy wonks have implicitly defined the solution as more of the same dysfunctional, bankrupting model that got us here. And that Ezra, is the lesson that we should take from Massachusetts.

Posted by: Athena_news | October 26, 2009 10:48 AM | Report abuse

constans, if that's the case then maybe Ezra ought to listen to the people with good arguments instead of the stupid ones.

Posted by: ab13 | October 26, 2009 10:49 AM | Report abuse

But Massachusetts hasn't taken any actual steps to control costs. I mean, they've put out a report that says they SHOULD control costs-what've they actually done about it?
Do we really want to drive up premium costs and drive our nation deeper into debt in the hopes that Congress actually grows a pair someday?

Posted by: jfcarro | October 26, 2009 11:02 AM | Report abuse

jfcarro is right: there are reports that MA has not controlled costs. For empiricists Krugman to ignore any details of those in his article was unusual. But in any case this is not the first time Krugman has been easy on details when it favors Liberal policy. His article in NYT was not convincing. It cannot be until 'cost' issues are addressed cleared and squarely. Of course doctors are going to be happy when they get more business and better rates.

I would expect Ezra to provide these details. Those are not there.

It seems that in the end PO backers and many Liberals are going to win - they are going to get 'cost irresponsible' Health Care Reforms as today's morning news is telling us. Fred Hiatt's and Samuelson's columns in WaPo are probably too late to change anything here; Congress do want to move ahead with much less constraints and without having cost questions addressed in any convincing manner. Senate will be waiting for CBO estimates, but by now we all know limitations of even those estimates.

We could be all lucky and this all will work out well. But generally we know that, when it comes to money and costs, things do not work automatically, magically. This means potentially we Americans will have to brace some tough situation after few years again.

Posted by: umesh409 | October 26, 2009 11:17 AM | Report abuse

ezra,

did your doctor friend you spoke to watch the 60 minutes piece last night on Medicare fraud and abuse? Any chance you want to touch on that subject? Many of those of us arguing against the single payer model are actually arguing against it because of the fraud and abuse that's rampant in the medicare and medicaid system. no matter what constans and his friends say and how much he chooses to degrade us.

Why would you give "TONY" the keys to the candy store?

http://www.youtube.com/watch?v=QwU7xc38-cc


Instead of linking to cute, funny scenes from the Office, you may want to link to this to see where we'll be in 20 years if the government gets full control of healthcare. But hey, Tony will be out of prison by then and back to work. THe best part of the piece last night was that one storefront that never had any people coming in and out did more business than the largest pharmacy in the state of Florida and NO ONE HAD A CLUE.

Posted by: visionbrkr | October 26, 2009 11:33 AM | Report abuse

"Fred Hiatt's and Samuelson's columns in WaPo are probably too late to change anything here"

Let us very much hope so. We can do without the Village Elders' sniffiness, coming from people who have minions for their minions to deal with the crap dumped down by American Healthcare Inc.

I'm guessing that Ezra isn't in a position to discuss Fred 'Wrong About Everything' Hiatt's column. The basic either/or premise in his conclusion is a shambolic, strawmannish false dichotomy. The point of a public plan is that it operates *for the benefit of those it serves*, not for the benefit of those who provide it.

To Lord Freddie of the Potomac, that's apparently either inconceivable or too difficult to engage with.

Posted by: pseudonymousinnc | October 26, 2009 11:34 AM | Report abuse

Oh, visionbreaker, you workshy fop, just because you offer up the same tedious, self-serving, buck-passing whine doesn't mean that you can pretend that people haven't addressed your "greedy doctors, stupid patients" thing. Or the "fraud and abuse" thing.

You're never going to stop whining and acting like you're the only noble and virtuous people in the business. Sorry, no-one buys it.

Posted by: pseudonymousinnc | October 26, 2009 11:40 AM | Report abuse

pseudo,

ok then. tell me how your public option controls costs? If you think Hiatt is wrong, Samuelsson is wrong then how does the public option control costs. I'd love to hear your explanation for this. I'll wait.

Are you saying that AG Holder is LYING and there isn't $90 BILLION annually in fraud in Medicare and Medicaid?

Posted by: visionbrkr | October 26, 2009 11:44 AM | Report abuse

*you may want to link to this to see where we'll be in 20 years if the government gets full control of healthcare.*

People will get treated, instead of dying, I'd assume, which was the same outcome of the Medicare program. Unless, as you seem to think, Americans are too stupid and evil to implement it.

Or maybe you'd like to stop driving on those government roads because you believe that they are built entirely fraudulently by Americans that are too stupid and incompetent to build them and drive on them.

Posted by: constans | October 26, 2009 11:52 AM | Report abuse

visionbrkr is making another variation of the common Republican argument that government is too incompetent to offer a public option, and that everyone will switch to that option because it will be so much better than traditional insurance, driving the insurance companies (and him) out of business.

Posted by: constans | October 26, 2009 11:55 AM | Report abuse

constans,

well sure those people will get care and I'm all for that as I've said many times but none of you seem to believe. My issue is who is going to pay for all of this?? Imagine how wealthy "TONY" is going to be. Now he just has access to the Medicare system and its what $600 billion of annual costs. Imagine if he got a shot at the whole pie the weasels that would come out. let's see at 10% in about 20 years when healthcare annually costs about $4 trillion he'll get his share of $400 billion. Nice haul for Tony I'd guess.

Talk about an up and coming industry.

I think you and your friend Pseudo . . . need to be introduced to a new word that you seem to have no idea about. Its called COST. see below for details:

1. the price paid to acquire, produce, accomplish, or maintain anything: the high cost of a good meal.
2. an outlay or expenditure of money, time, labor, trouble, etc.: What will the cost be to me?

Why is it that when you speak of the reforms you don't even mention this word???

Posted by: visionbrkr | October 26, 2009 12:04 PM | Report abuse

How's the Federal H1N1 vaccination program going? Will health care reform proposals work as well?

Posted by: rmgregory | October 26, 2009 12:08 PM | Report abuse

constans,

no they're competent enough to offer it. THey're just not competent enough to do it well as Attorney General Holder readily admits.

Do you have an explanation as to why Medicare does not credentialize providers to ensure a great reduction in fraud as insurers do? Even when the woman in the piece called Medicare to "red flag" her account the only response she got was "thank you for your inquiry, we'll get back to you" and they never did. Not a surprise?

Oh and what is it you do? What's your reasoning for being on here??? Ya I never did think I'd get an answer.

Posted by: visionbrkr | October 26, 2009 12:08 PM | Report abuse


at some insurance carriers 100% of claims from Florida are flagged for additional fraud review due to the combination of prevalence/weak state regs. Not an argument against Medicare so much as against a state suspiciously lack-luster in their regulation and licensure requirements.

And Athena: "It's not surprising that providers in Massachusetts are happy with the insurance mandate given that its major objective was to see that they got paid. It's one of the most provider saturated markets in the US and also one of the highest cost." -that argument falls apart when you consider that, yes, costs are higher but physician compensation is LOWER in Massachusetts.

Posted by: ThomasEN | October 26, 2009 12:27 PM | Report abuse

How's the Federal H1N1 vaccination program going? Will health care reform proposals work as well?

Posted by: rmgregory | October 26, 2009 12:08 PM | Report abuse


oh come on now they only had a year to get the immunzations ready for this. that's not nearly enough time. But on the good news front as per constans you'll have a great smooth ride on your "government roads" on the way to the hospital, or the morgue.


YAY!!

Posted by: visionbrkr | October 26, 2009 12:44 PM | Report abuse

ThomasEN makes a good point. Interesting that Mass physician work hours and income have not increased since much since reform. Perhaps more people have health insurance, but the number of people getting health care is about the same???

http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=29405

Posted by: bmull | October 26, 2009 1:13 PM | Report abuse

Once again, visionbrkr is arguing that Americans are uniquely incompetent and stupid... well, all the Americans with the exception of his own abusive private insurance industry.

*Interesting that Mass physician work hours and income have not increased since much since reform. Perhaps more people have health insurance, but the number of people getting health care is about the same???*

Or perhaps that people and doctors prioritize their own treatment decisions better since more people are asking for care?

Lots of fee-for-service health care professionals will have a certain monetary goal they want to hit for the year and will adjust their practices to hit that threshold. If they have more patients than usual, this means they need to hustle less for work, so they make just as much money and work just as many hours as before.

Posted by: constans | October 26, 2009 3:34 PM | Report abuse

constans,

what is it you do? ___________

Here let me make it easier for you:

1-constans is a doctor that hates insurance companies.

2-constans is a patient that was denied care from an insurance company

3-constans is a liberal blogger.

So which is it, 1,2 or 3?

Why is that such a hard question for you to answer. Plenty on here have answered the same. Why is it that you and pseudo won't be honest with me???


And no there are a lot in my industry that are stupid. In fact the entire industry should have held firm together in the capitation model and not put us in the mess that we're in today with cost.

Posted by: visionbrkr | October 26, 2009 3:57 PM | Report abuse

Um, actually visionbrkr, I think you are right sometimes for the wrong reasons. You are using the meme "government is bad and incompetent" to explain everything. So you condemn BOTH single-payer and the public option. AS it turns out a single-payer system is going to control costs more. Medicare fraud and abuse at a grand scale (if it exists on the scale that conservatives claim...there will always be some fraud and abuse in any system) is only a "feature" of government run insurance if you don't look outside our borders. However how does Canada manage better health outcomes with 30% less money?

Apparently there is a way to administer government run health insurance fairly efficiently....I'm sorry! Eoes that endanger your ideology? ... Those darn facts!!!

And yes, the public option is not a good cost control mechanism unless it is an "on-ramp" to single-payer.

Posted by: michaelterra | October 26, 2009 6:16 PM | Report abuse

michaelterra,

actually they're (government) not bad, just incompetent and underfunded. I think the Democrats "want to do the right thing". They just don't realize that fraud in their system is impossible to root out. if it wasn't impossible to root out then why haven't they in the 40+ years of medicare??

Yes single payer would control costs more than a public option but not nearly enough. Don't you realize that socialized medicine countries are dealing with access, cost issues too. This is not solely a US problem.

And do you really think that 60 Minutes is conservative???

http://www.cbsnews.com/video/watch/?id=5419844n

Is Eric Holder lying here???

MY GOD THERE SHOULD BE AN INVESTIGATION if he is. Forget what Alberto Gonzalez did this guy is a real liar.


Some fraud and abuse is a couple percent. When its 10-15% of the system (AS ADMITTED BY THE GOVERNMENT IN THE 60 MINUTES PIECE THAT EZRA WON'T COMMENT ON).

Please explain to me why in Medicare ANYONE can be a provider. heck you and me could be Medical suppliers submitting claims. We don't have to have medical supplies.

Do you need a couple electronic arms? It doesn't seem too hard to get them paid for?

Oh and when you get down to single payer you still eventually need to deal with increased utilization. Nothing in the reforms deal with that.

Posted by: visionbrkr | October 26, 2009 6:36 PM | Report abuse

"Here let me make it easier for you:"

--visionbreaker is a health insurance broker who doesn't appear to do much work. This is why he's oh so curious about people who aren't health insurance brokers who don't do a lot of work.

I mean, I wouldn't call it "fraud, waste and abuse", which gets him all hot under the collar, but he's not exactly working up a sweat.

Posted by: pseudonymousinnc | October 26, 2009 6:57 PM | Report abuse

--"[T]he Bay State has shown that the basic combination of a mandate, subsidies and an exchange can work to radically increase coverage."--

Yeah, the miracle of state police power is AWESOME, Klein. Nothing like *forcing* people under the rubric of law to buy something, and then claiming success when they choose not to shoot it out when the state's thugs come around to collect.

Posted by: msoja | October 26, 2009 7:13 PM | Report abuse

--"[T]he Bay State has shown that the basic combination of a mandate, subsidies and an exchange can work to radically increase coverage."--

Yeah, the miracle of state police power is AWESOME, Klein. Nothing like *forcing* people under the rubric of law to buy something, and then claiming success when they choose not to shoot it out when the state's thugs come around to collect.

Posted by: msoja | October 26, 2009 7:13 PM | Report abuse

--"[T]he Bay State has shown that the basic combination of a mandate, subsidies and an exchange can work to radically increase coverage."--

Yeah, the miracle of state police power is AWESOME, Klein. Nothing like *forcing* people under the rubric of law to buy something, and then claiming success when they choose not to shoot it out when the state's thugs come around to collect.

Posted by: msoja | October 26, 2009 7:17 PM | Report abuse

Oops.

Posted by: msoja | October 26, 2009 7:20 PM | Report abuse

pseudo,

for about the 100th time I think everyone on here knows what I do. No one seems to know what you do though? Why is that? hmmm.

are you defending Medicare fraud? Are you really Tony from that 60 Minutes piece? no wonder you want single payer. That'll be a windfall for you pal!

And as for how much work I do, I know how to multitask. I don't go searching for new clients and only resolve issues for my existing ones as they come up (as i've mentioned to you before).


Multitasking. its kind of like how you can go from liberal blog to liberal blog all day long and post. Exactly what is it you do anyway??? Ya, I thought so. One of these days you'll have to come clean and let us know.

Posted by: visionbrkr | October 26, 2009 7:29 PM | Report abuse

I don't go searching for new clients and only resolve issues for my existing ones as they come up (as i've mentioned to you before).


--and furthermore since my clients are very happy not many issues come up. Cost seems to be the only issue for them which I why I'm for the "right type" of reform. Not reform that makes the employer system worse. Not reform that gives a watered down individual mandate. Reform that actually addresses that EVIL 4 letter word that you liberals and progressives never speak of:

COST

Posted by: visionbrkr | October 26, 2009 7:32 PM | Report abuse

Oh, now I understand visionbrkr's excessive number of posts and hysterical tone. He is worried about his professional future and is kind of a salesman, who's MO is to use FUD to sell his wares. Got it...

Posted by: michaelterra | October 27, 2009 1:36 AM | Report abuse

michaelterra,

irregardless of what i do, again you don't bother to answer my question. How does giving the entire healthcare pie to the government who so mismanages it via fraud and abuse a good thing?

As I've said before medicare and medicaid fraud and abuse is >>>> insurers profits.


And why does what I do factor into it? Do you not have an agenda for being on here?? Even if the government took over everything via single payer you don't think I would work as a consultant for employers to get them through the mess of the government? I've already had 5 of my larger clients contact me to make sure we could still do that for them and I had to talk them off the ledge that we weren't there yet and wouldn't likely be for many years. My position is safe no matter what but the question is how much less expensive is the private insurance system than the Medicare system when you factor in the true costs including fraud and abuse?

Why don't you answer my questions on Medicare fraud and the 60 minutes piece?

Posted by: visionbrkr | October 27, 2009 8:34 AM | Report abuse


whoa whoa whoa visionbrkr, I don't mind if you go on and on about fraud in Medicare ignoring the obvious which is that higher levels of reported fraud means that Medicare does a BETTER job detecting fraud and that, probably, the private companies that you hear less about (fraud-wise) with claims adjudications systems built on crappy AS/400 systems from the 80's trying to remediate claims based on 15 year old contract data haphazardly trying to figure out whether to pay based on national ppo rates, local ppo silver/gold/platinum/super-duper diamond rates, local hmo silver/gold/platinum/super-duper diamond rates, based on contracts that, incidentally, no one can even find hard copies of, yeah, those guys aren't susceptible to fraud AT ALL. Right. No fraud happening there. That's fine. Go ahead and argue that the payer that has one plan type is more susceptible to fraud than the payer that has a bazillion plan types. I'll let that slide.

However, what is utterly unacceptable, utterly, utterly unacceptable is using the word "irregardless". Come on dude.

Posted by: ThomasEN | October 27, 2009 11:43 AM | Report abuse

ThomasEN,

forgetting my grammatical error (sorry an Econ major, not English), Medicare is NOT detecting fraud, that's the problem. They're barely scratching the surface and they admit that. They know that they could fully pay for the reform if they got rid of all fraud (which we all know is impossible for either public or private to get rid of all fraud)

With insurers fraud doesn't get in as easily and it was easily explained in the piece.

WIth insurers, providers need to be contracted. It takes longer, costs more but providers are legitimate. A rep from the insurance company (or network system, ie Multiplan, Beech Street etc) goes out to see the provider, makes sure they're up to par etc. With Medicare, it doesn't work that way. ANYONE CAN SUBMIT CLAIMS. All you need is the info to submit. The person's Medicare ID number (their SSN and the letter B for Part B claims) and their date of birth and address and, VOILA. Medicare fraud.


Insurers have claims and codes that are "red flagged" if they come in with potential fraud. With many insurers then that provider's claims are taken off auto ajudication and moved to a claims examiner.

I don't know as much as obviously you do about the systems and the super-duper diamond rates or the AS/400 systems but I do admit there is some fraud in private healthcare systems but to anyone that I've ever spoken to about it, its not nearly what's in the public sector. That's my concern.

Is this better?

medicare and medicaid fraud and abuse is >>>>> private insurers profits and their fraud and abuse.

Posted by: visionbrkr | October 27, 2009 12:22 PM | Report abuse


I should probably watch the piece first; but generally speaking, I'm inclined to blame Florida. Your state's division of insurance might require site visits for purposes of enrolling a new provider whereas other states don't. NCQA even dropped their site visit requirement for contracting about 3 years ago (it changed to a complaint-driven model when they blended their HMO and PPO accreditation requirements; it's much harder to require site visits in a big-ass PPO so they dropped it). If Florida had the same site-visit requirements as your state's division of insurance or professional licensure division I'm guessing - again, haven't seen the piece - the Medicare fraud instances would plummet.

Posted by: ThomasEN | October 27, 2009 1:22 PM | Report abuse

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