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The Massachusetts plan is working -- but the American health-care system is not

In recent weeks, critics of the Affordable Care Act have turned their attention to Massachusetts, where there's some evidence that the reforms signed into law by Mitt Romney in 2005 are struggling: Emergency room visits haven't dropped. Gov. Deval Patrick has been tussling with insurers over rates. There's anecdotal evidence of small employers dropping coverage (though recent studies show employer coverage expanding).

Before getting into isolated statistics and anecdata, let's do an overview: Between 2006 and the fall of 2009 (which is the most recent data [pdf] we have), insurance coverage among non-elderly adults jumped from 87.5 percent to 95.2 percent. Access to preventive care went from 70.9 percent to 77.7 percent. The gap in coverage between minority and non-minority residents disappeared. Out-of-pocket costs fell. These gains have persisted amid the recession, which is something of a surprise. State insurance plans tend to unravel during recessions.

Cost, however, is where things get complicated. In the non-group market -- which is where the reforms were concentrated -- premiums costs fell by 40 percent in Massachusetts even as they rose by 14 percent nationally, according to data from the insurance industry trade group AHIP. In the employer market, which did not see major reforms, costs have risen at about the national average: The increase in Massachusetts has been 21 percent, while the increase in the rest of the country has been 21 percent.

The plan's popularity also remains quite high: The Urban Institute study found approval at 67 percent in fall 2009.

Now, let's dig in a bit.

The Massachusetts reforms, unfortunately, were not designed to deal with cost. They weren't even designed to improve the delivery system. There was no excise tax, no independent commission to fast-track cost controls, no efforts to generate evidence for comparative effectiveness reviews or seed the system with medical records or spark a shift toward medical homes or accountable care organizations. "The initiative was to expand coverage and that still is going very well," says Sharon Long, who is studying the reforms for the Urban Institute. "They were very successful early on and they've managed to maintain that success despite the recession. The challenge is the cost issue, which they did not tackle in the initial reform."

Before the reforms, Massachusetts had the highest health-care costs in the nation. That's still true after the reforms. Massachusetts has an incredibly powerful hospital industry. Think of the legendary research hospitals in Boston -- Harvard and Tufts and Partners. Their reputation allows them to command huge premiums, and their centrality to the economy ensures them huge political power. Long mentions a survey that found one out of five households in Massachusetts gets some income from the health-care industry.

Some of the attention, however, is the product of politics, not policy. Various Massachusetts observers noted that Patrick has gone to war against the state's insurers -- but not because of the reform plan. Patrick is running for reelection against Charles Baker, the former CEO of Harvard Pilgrim, a large insurer in Massachusetts. So he's making the insurance industry an issue in the campaign. In fact, the insurer whose rates he overturned was ... Harvard Pilgrim. This all seems normal enough as a matter of politics, but because it's Massachusetts, it's become part of a conversation over the state's reforms.

But it doesn't really belong there. What we can say about Massachusetts now is pretty much what we've been able to say about Massachusetts since the early days of its implementation: It's been a successful attempt to expand coverage and reform the non-group market, and it was never an attempt to control costs. As such, costs in Massachusetts, much like costs nationally, are rising. Insofar as that contains lessons for the national effort, it's that we should stick to the law and make sure to implement the cost controls and delivery-system reforms.

By Ezra Klein  |  July 19, 2010; 5:45 PM ET
Categories:  Health Reform  
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Comments

...and don't forget that Massachusetts gets a few extra federally-collected taxpayer dollars to help pay for its Medicaid program. Such extra bucks always help make the calculations look a little better.

Factual information regarding the Massachusetts health care reform problems has, to date, been difficult to find. Certainly, everyone now discounts information from the corporate lobby group Center For American Progress Foundation (CAP), which recently apologized to those it slandered by one of its manufactured video clips (http://thinkprogress.org/2010/07/14/tea-party-racism/). Given renewed recognition of the bias present in information disseminated by CAP -- the current employer of the Obama/Pelosi Regime's former health care spokesperson -- truthful information regarding the PPACA ad its devastating impact on state and federal budgets is slowly emerging.

Posted by: rmgregory | July 19, 2010 6:33 PM | Report abuse

Let's get back to Math 101.


a $20,000 annual premium which receives a 21% increase in cost is now $24,200 in Mass. for example

a $10,000 annual premium in say Wisconson that receives the same 21% increase is now at $12,100.

So the actual dollar increas is $4200 vs $2100 and the cost of the insurance is STILL twice in MA as what it is in WI.


Lesson of the story, you can't mix dollars and percentages Ezra when trying to make your points about costs being contained in MA in relation to the rest of the country.


I'm glad you at least half-heartedly admonished Gov Patrick for his politicizing of the issue. Should have been much stronger though.


I also don't know MA like I know NJ but I'd expect that the group market DID go through reforms, maybe slightly different reforms.

http://en.wikipedia.org/wiki/Massachusetts_health_care_reform

excerpted from the above:

"But the DHCFP also reports that many of the non-profit insurers spent more on healthcare services than they took in in premiums in 2008-2009"

"As of early 2010, the Massachusetts-only non-profit insurers themselves are warning of bankruptcy or failure if further 10%-30% premium increase are not approved for 2010-2011"

I'm thinking it'll take one or several insurers to go bankrupt before people start paying attention.


Posted by: visionbrkr | July 19, 2010 6:37 PM | Report abuse

Ezra,

As a Massachusetts resident, I should also add that the Bay State also has the lowest cost-sharing in the nation (http://content.healthaffairs.org/cgi/content/full/25/3/832/T3): whereas in 2002 the national average actuarial value in job-based health insurance was 81.4 percent nationwide, that figure was 87.6 percent in the Bay State. Only one-third of Massachusetts residents in employer-based health insurance face deductibles; that figure is 65 percent nationwide. In other words, Bay State residents may be paying more, but they're also getting a whole lot more for what they pay.

Posted by: moronjim | July 19, 2010 6:39 PM | Report abuse

Excuse me -- that average nationwide actuarial value in job-based insurance should be 83.4 percent -- not 81.4 percent.

Posted by: moronjim | July 19, 2010 6:47 PM | Report abuse

I should also add that Massachusetts also has more mandated benefits than almost any other state -- maternity care at low cost-sharing arrangements, unlimited in vitro fertilization attempts, mental health, mental health parity, alcohol abuse treatment, etc. all are required to be covered in an insurance policy.

Posted by: moronjim | July 19, 2010 6:58 PM | Report abuse

"I should also add that Massachusetts also has more mandated benefits than almost any other state -- maternity care at low cost-sharing arrangements, unlimited in vitro fertilization attempts, mental health, mental health parity, alcohol abuse treatment, etc."


One of those things is not like the others. Its an outrage that public taxpayer dollars are going to pay for purely elective therapies such as IVF. You are aware that IVF costs upwards of 20k per cycle correct?

Its the same thing as the state of Mass paying for boob jobs or liposuction. Ridiculous waste of money. Furthermore, its an effective tax on the poor to support the rich since the vast majority of people seeking IVF/REI therapies are upper middle class white people. Poor black folk and latinos are getting screwed here.

Posted by: platon201 | July 19, 2010 7:09 PM | Report abuse

@platon201: Yes, I am well aware of the costs of in vitro fertilization. I'm also well aware of my aunt's friend whose three children were all neonatal births. What do you say to someone like her?

That said, I agree that IVF is different than the other mandated benefits I mentioned. An insurance policy should be required to cover maternity care, mental health, prescription drugs, DME, prosthetics, etc. at some level. I'm not sold on mandating coverage of IVF.

Posted by: moronjim | July 19, 2010 8:47 PM | Report abuse

moronjim,

I'm sorry but there's a little thing in healthcare called medical necessity and IVF doesn't cut the mustard. I feel badly for anyone that can't have children that wants to. Doesn't mean I should have to pay for it. Not to mention that studies show correlations between IVF and levels of preemies and ongoing issues that costs into the hundreds of thousands or millions. Sorry not going to fly.

Posted by: visionbrkr | July 19, 2010 8:54 PM | Report abuse

I have to applaud Mass. for at least trying. Health care reform is needed across America, but much can be done at the state level. I hope other states follow their lead and start looking at what similar programs could be used in their states.

Posted by: clejeune | July 19, 2010 9:17 PM | Report abuse

--"[W]e should stick to the law and make sure to implement the cost controls and delivery-system reforms."--

WHAT cost controls? WHAT delivery system reforms?

There aren't any.

Everything you write, Klein, is a load of hooey.

Posted by: msoja | July 19, 2010 9:34 PM | Report abuse

--"Certainly, everyone now discounts information from the corporate lobby group Center For American Progress Foundation (CAP), which recently apologized to those it slandered by one of its manufactured video clips (http://thinkprogress.org/2010/07/14/tea-party-racism/)."--

Have they apologized? The fraudulent clip is still up. They removed one small segment of it, days ago, but the entire thing is a fraud, and as far as I can tell, ThinkProgress is hunkered down while the more responsible end of the blogosphere rips them up one side and down the other.

Apparently, the ThinkProgress employees are willing to suffer the slings and arrow without shame because they never had any to start with, and their followers haven't any, either. The fanatics just don't care. What they do is not about truth or principle. It's about the hate they can project. As I've remarked on my own blog, Yglesias (Klein's pal) is a day in and day out reprobate, and the ThinkProgress Editor/Vice President, Faiz Shakir, is an incompetent and a fraud. There are calls for Shakir's firing, but no one at ThinkProgress cares. They're not in the business of producing items reflecting integrity. They're in the business of churning out reams of propaganda, and they do that very well (except when they get a little too cute, as with the aforementioned video.) And their ignorant, fanatical followers (aka useful idiots) are there to validate ThinkProgress's efforts.

And do note the ongoing symbiosis between Klein and ThinkProgress. It's a little link circle wank.

Posted by: msoja | July 19, 2010 10:32 PM | Report abuse

According to this study referenced in the economist that healthcare reform in Massachusetts decreased length of stay and the number of inpatient admissions originating from the emergency room. http://www.economist.com/blogs/freeexchange/2010/06/health_care

Amongst a lot of other things.

Posted by: zosima | July 19, 2010 11:47 PM | Report abuse

I think Maryland has done the cost control thing pretty nicely. How feasible is it to implement something similar nationwide?

Posted by: mschol17 | July 19, 2010 11:56 PM | Report abuse

--"[H]ealthcare reform in Massachusetts decreased length of stay and the number of inpatient admissions originating from the emergency room."--

They also say that "the cost of health care" did not increase. Even Klein can't not admit that Massachusetts health care costs continue to rise.

And it's another of those $5 links that Klein has been resorting to, lately.

But, at end, you're only arguing about whether the trains are running on time, or not. That's not what I would call stimulating discussion among intelligent adults. How much or your fellow's livelihoods are you willing to throw over for a point or two gain in *alleged* health care outcomes?

Posted by: msoja | July 20, 2010 12:08 AM | Report abuse

This is a *completely* misleading article. The insurers in Massachusetts are suing to raise insurance rates to the level to which they need to be raised to cover the risk. They are looking at 32% increases in some cases, which are being prevented by the state, temporarily. To say that premium costs dropped 40% is pure fiction or fantasy.

As in most cases, it is the lack of sufficient deductibles and the excessive minimum requirements for coverage which drive overuse and non value driven use of health care services and products, it is just more extreme in MA, as it will be in the country at large when plans that "give" too much have to be paid for.

It's just shows the complete stupidity of so many people to bleat on about how wonderful their plans our because they have lower out of pocket costs when collectively everyone is paying more for medical care and costs are rising faster than ever. It's an irrational trick. These are probably the same people that buy insurance on all of their consumer electronics from Best Buy. Romney is such a fool, I can't believe that kind of person wasn't that far from the presidency. I can't believe the much smarter man that was elected doesn't see that HSAs are a preferable form of cost control to this mess.

Posted by: staticvars | July 20, 2010 12:13 AM | Report abuse

--"I think Maryland has done the cost control thing pretty nicely. How feasible is it to implement something similar nationwide?"--

Klein propagandized about Maryland back in March. Of course, the only inkling of the truth of the matter is in the comments.

http://voices.washingtonpost.com/ezra-klein/2010/03/how_maryland_controls_health-c.html

Medicare and Medicaid are held to different standards in Maryland, and when you get right down to it, Maryland isn't really doing better than any other state, saddle as they all are with noxious Fed and other self-inflicted regulations and requirements.

As to the feasibility of rolling one state's program across the country, ordinarily you'd run up against the Constitution, but heck, you know.

Besides, the country is more or less committed to RomneyCare now, so dreaming about the equally fascist MarylandCare is kind of silly.

Of course, you are free to play health care arm chair quarterback for the rest of your life, for all the good it will do you, and I wish you the best.

Posted by: msoja | July 20, 2010 12:24 AM | Report abuse

There are plenty of non-anecdotal, consistent and statistically significant data points concerning Romneycare. They are normally produced quarterly by the Department of Healthcare Finance and Policy of the State of Massachusetts in a report called Key Trends (see the web site). That was done from 2006 through February 2010.

The state government's own data shows how the healthcare delivery system is collapsing in Massachusetts in terms of number of uninsured rapidly increasing (not a typo), costs, lack of solvency of the insurers (the leaders being non-profits by the way), the ER visit info (spinning that into a positive takes incredible chutzpa), etc.

A great example of spin from this newspaper is cutting the already biased data from the Urban Institute to include only the "non-elderly." Who to hell do you think uses the healthcare?

And given the way the data is pointing, guess what? Note that I said quarterly and that the last report came out in February 2010. Apparently the deterioration continues because the latest data is now 60 days overdue.

More playing politics by the Governor and his administration although one brave civil servant has called it correctly: the Insurance Deputy Commissioner says it's a "train wreck." (That's right, that quote comes from a Massachusetts state employee, not the Wall Street Journal as Obamanistas like this newspaper would lead you to believe.)

Posted by: byrondennis | July 20, 2010 2:23 AM | Report abuse

Ezra is right!

This bill has "no independent commission to fast-track cost controls, no efforts to generate evidence for comparative effectiveness reviews"!!!

Federal Death Panels run by heartless communists like Don Berwick, Ezekiel Emanuel, John Holdren will clearly reduce costs by imposing the North Korean healthcare rationing model.

Posted by: FastEddieO007 | July 20, 2010 8:04 AM | Report abuse

Ezra:

This word "success" you keep using. I do not think it means what you think it means:

http://insureblog.blogspot.com/2010/07/ezra-klein-whiffs-it.html

Posted by: hgstern | July 20, 2010 9:28 AM | Report abuse

I think another commenter made the point about the real cost numbers in Mass being masked by the fact that the federal government (i.e., all of us taxpayers outside of Massachusetts) are picking up the bill for a lot of their real cost increases, and those are conveniently left out of the numbers Ezra quotes. Here's a link if you care to see the facts Ezra is trying to spin. And note the source is CNN, not some right-wing hate-mongering blog.

http://money.cnn.com/2010/06/15/news/economy/massachusetts_healthcare_reform.fortune/index.htm

Truth is, the real costs of health care 'reform' in Massachusetts are being hidden, and taxpayers in the state are bound to get kicked in the teeth down the road with skyrocketing tax increases to cover the 'unexpected' costs of government run health care.

On a completely unrelated note, the early parts of Obama/Pelosi 'reform' are just getting started, and cost estimates since the bill was passed have already taken Obama's bill from a 10 year savings of $140 billion (remember Nancy waiving the CBO report around?) to an addition to our deficit of $200-$300 billion. Folks, that's a miss on forecasted costs of 35% already, and we aren't even really started yet.

Posted by: dbw1 | July 20, 2010 9:32 AM | Report abuse

hgstern:

Thanks for the link to the "Ezra-whiffs-it" blog. I picked up on Ezra's half-baked economics a long time ago, and check in once in awhile if I want to see what is lurking in the fanciful unlearned mind of a "progressive" who's unrelenting in his pursuit of a nirvana-economy that doesn't exist.

Keep in mind two common-sense flaws with 'progressive' ideas of what health care reform should look like:
1) if you could wait to buy auto insurance until AFTER you have an accident, and the insurance company could not deny you coverage as you fill out the application standing beside your totaled car, would you have any reason to pay market-cost for auto insurance and carry it all the time?
2) if you have never had a car accident, and have never gotten so much as a speeding ticket, should you be required to pay the same rate for auto insurance as your neighbor who has totaled 3 cars in the past 12 months, and has a glove-box full of speeding tickets?

Both principles are elements of what Ezra considers "successful" health insurance reform.

Posted by: dbw1 | July 20, 2010 9:43 AM | Report abuse

maybe Ezra's definition of "working" means "working to destroy the financial stability of Mass."

Did he not even read his own Wonkbook that had a detailed article for Robert Samuelson?

From that article:

In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.


So basically Ezra we're just hiding the costs. We're still paying them and every other state function is being held ransom to healthcare costs but sure its working. You keep believing that.

Posted by: visionbrkr | July 20, 2010 9:45 AM | Report abuse

Medical homes face a public awareness problem. The solution? Scenarios that work. http://www.healthcaretownhall.com/?p=2880

Posted by: JEngdahlJ | July 20, 2010 12:12 PM | Report abuse

@visionbrkr: Yes, medical costs in MA are going up. They are also going up for practically every state, with many states seeing as dire a budget situation as MA in regards to medical costs. None of this has to do with the actual reform itself that MA passed.

Ezra made it very clear the program is a success by some measures - by coverage amount and impact of individual premium costs. He also made it clear that MA's reform did not address costs in any meaningful way.

The reform did what it was set out to do: it increased the number of insured and helped the poorer members of society afford health care. All in all not bad.

Posted by: Zotnix | July 20, 2010 2:58 PM | Report abuse

@zotnix,

but as you can see the MA budget is busting at the seems from the increase from 16% of the budget to 35% with health spending. At some point very soon that's not sustainable.

Sure if you're only issue is let's get people coverage then yes it was a success. That's like saying the mission in Iraq was a success because the Defense Dept spent money. Equally idiotic.


And they're not "affording healthcare" they're being handed healthcare. 40+% (from the Samuelson piece) aren't paying a penny towards their care. That's fine if you're all aware of that but again UNSUSTAINABLE.

Posted by: visionbrkr | July 20, 2010 4:27 PM | Report abuse

@visionbrkr None of that has to do with the actual reform MA passed. It has to do with ballooning health care costs across the country. As the title of the post says, "The Massachusetts plan is working -- but the American health-care system is not."

I conceded that the health care costs in MA are ballooning, but again, this is happening everywhere and this is happening independent of the reform MA passed.

Also, it is helping members of society afford health care by subsidizing those costs. That does impact the budget, but there's a difference between someone making $15,000 getting cheap health care and MA not having sustainable health care expenses.

Posted by: Zotnix | July 20, 2010 4:54 PM | Report abuse

Zontix,

NEITHER ARE WORKING.

The only difference is that Mass. is handing out free healthcare to 40% of its population due to the fact that it is a "wealthy state". You think Mississippi can afford that? Alabama?

Saw a great article online on poltico today that I hope that Ezra would link to in Wonkbook tomorrow about the high risk pools and how higher income on average and states with somewhat GI are running into issues with high risk pools.

The point of the matter is that it COULD actually help people afford the costs in the long run and not just for a short time BEFORE the state goes bankrupt if they actually cared to tackle costs. I was hopeful that State Senate President Murray would do that. Seemed like she had some ideas for that but it got squashed seemingly by the doctor/hospital consortium in MA. Sad state of affairs. Hypocratic oath indeed.

Posted by: visionbrkr | July 20, 2010 10:50 PM | Report abuse

Cost in MA are out of control, yet Ezra glosses over this key reality that will damn ObamaCare and RomneyCare as nothing more than second-class programs that will hit hard times as soon as the populace wakes up that they mean slower access and lower quality.

Posted by: rethman | July 21, 2010 10:11 AM | Report abuse

DOJ allowing Federal Contractor T42CFR417.1 Hospital and Nursing Home DUMPING - 1998 still pending 2010, to force illegal STATE Medicaid kickback conversion - 1998 alternate T18CFR1518CRIME dispute resolution - racketeering against federal beneficiaries T42CFR417.1 criminal, physical and financial misconduct - denial of civil and criminal rights for rule of law. Protection from Abuse of OFFICIAL Authority is fundamental in a society governed by the Rule of Law and democratic principles.
.
1999 ~ At their initial meeting in 1999, the NATIONAL Health Care Fraud and Abuse TASK FORCE, Chaired by the Deputy Attorney General [ ERIC HOLDER - ANTI TRUST ] set various goals toward working together to PROTECT [ FALSE CLAIM ] the Vulnerable NURSING HOME population and in Stepping Up Efforts to EXCLUDE DISHONEST PROVIDERS [ FALSE CLAIM ] from [ HCFA|CMS ] Medicare, Medicaid and other [ OPM FEHB - CHAMPVA - TRICARE ] Federal Health Programs.
.
REGARDING -- Before the reforms, Massachusetts had the highest health-care costs in the nation. That's still true after the reforms. Massachusetts has an incredibly POWERFUL HOSPITAL Industry. Think of the legendary research hospitals in Boston -- Harvard and Tufts and Partners. Their reputation ALLOWS them to command HUGE PREMIUMS, and their 'centrality to the economy' ensures them HUGE Political POWER. Long mentions a survey that found one out of five households in Massachusetts gets some income from the health-care industry.

.

1998 - The Office of DISPUTE RESOLUTION [ racketeering - DOJ, HCFA and HHS|OIG|HMO T42CFR417.1 grievance procedure - illegal termination of Individual Federal Health Policies, to force, fraud by fright, illegal HCFA State Medicaid Kickback T42CFR409.33 Conversion - RICO - HCFA 1996 HIPAA Violation - T18CFR1518CRIME ] represents, and is working [ laundering ] on behalf of, The DEPARTMENT OF JUSTICE.

.

From: senator@stabenow.senate.gov
To: justmyopnion@aol.com
Sent: 3/23/2010 12:55:53 P.M. Eastern Daylight Time
Subj: Health Insurance Reform - T18CFR286CRIME
Dear Kimberly,
President Obama has just signed into law historic health insurance reform legislation called the [ 1987 ] Patient Protection and [ 2005 DRA ] Affordable Care Act.
In 6 Months... All new health plans will be required to [ FORCE ] allow Consumers to APPEAL [ Dangerous Provider OPM FEHB|HMO - HAPCORP.ORG Detroit MICHIGAN ] Insurance Company [ CRIMINAL T42CFR417.1 ] DENIALS of [ EXISTING Federal ] coverage and get an independent review [ OPM FEHB T5CFR890.105 systematic Denial of Covered T42CFR409.33 post HOSPITAL extended care NURSING HOME Claims - JUDICIAL REVIEW DENIED January 4th, 2004 Eastern District Court RICO MICHIGAN ] of their [ T42CFR417.1 criminal, physical and financial abuse RICO ] case.
Sincerely,
Debbie Stabenow D- Michigan INTIMIDATION T42CFR417.1 Unjust Enrichment for Dishonest, Dangerous Providers in HCFA|CMS Region 5 T18CFR242CRIME.
DISHONEST United States Senator - federal budget committee

Posted by: Justmyopnion | July 21, 2010 1:38 PM | Report abuse

msoja: "Everything you write, Klein, is a load of hooey."

Houston, we have epistemic closure!

Posted by: dasimon | July 22, 2010 12:02 AM | Report abuse

dbw1: "Keep in mind two common-sense flaws with 'progressive' ideas of what health care reform should look like:
1) if you could wait to buy auto insurance until AFTER you have an accident, and the insurance company could not deny you coverage as you fill out the application standing beside your totaled car, would you have any reason to pay market-cost for auto insurance and carry it all the time?
2) if you have never had a car accident, and have never gotten so much as a speeding ticket, should you be required to pay the same rate for auto insurance as your neighbor who has totaled 3 cars in the past 12 months, and has a glove-box full of speeding tickets?"

That's a misleading portrayal both of progressive proposals for health care and actual personal behavior.

As for 1), progressive plans call for a mandate to avoid precisely that problem. You can't have guaranteed issue (including no denial for people with preexisting conditions) without a mandate--or at least no peer nation has figured out another way. Progressives understand that guaranteed issue without a mandate will lead to a premium "death spiral" as healthy people refuse to get insurance until they get sick, making premiums more expensive for everyone else, causing more people to drop out, making premiums even more expensive, etc. So please don't tell progressives that guaranteed issue without a mandate will make for a "successful" system when no such system has been seriously proposed.

As for 2), there are plenty of incentives not to total your car. If you've totaled 3 cars in the past 12 months, there's a good chance you suffered some serious injuries (if you didn't kill yourself on the third try). And you might be liable for someone else's injuries, and you might be criminally liable. The existence of car insurance doesn't substantially increase the desire to be careless and get into accidents because accidents are dangerous.

Same goes for health care. There are already plenty of disincentives to seeing a doctor. How many wealthy people, who can consume as much health care as they want, do you see saying "Gee, I won't play golf today, I think I'll make a doctor's appointment instead"? People who take care of themselves will do so with or without insurance, and those that don't take care of themselves probably wouldn't do so regardless of whether they're insured or not. It's no fun having diabetes, and I doubt that having insurance would be a serious incentive to engage in behaviors that increase that risk.

Posted by: dasimon | July 22, 2010 12:15 AM | Report abuse

"The Massachusetts plan is working -- but the American health-care system is not..."
Attempted analysis of the Mass. Plan, with no evaluation of the major contributions from taxpayers in all 50 states.
MOSTLY HOWEVER -- The "American HC System" will not be fully in place for at least four years, due to all the political compromises required to secure passage of any plan at all -- AND LARGELY DUE TO THE GOP'S stubborn obstructionism.
As a conservative taxpayer, I strongly object to helping pay for grossly excessive incomes for Insurance Executives, Hospital Administrators, Medical Specialists and TOTALLY NEGATIVE political HACKS occupying the ultra-expensive seats in Congress.
These non-productive drones became full-time harping critics of "everything Democratic and Obama" as soon as this legitimately elected president secured his NEAR LANDSLIDE 2008 election victory.
Each and every GOP malcontent is costing millions to maintain in Washington. along with all state and district offices, bloated staffs, legitimate travel and pure nonsense junkets.
What we have received from the entire GOP "Hell NO!!" lock-sep bloc since January 2009 has been counter productive negatve opposition.
Now we get "The Massachusetts plan is working -- but the American health-care system is not" from another critic, years before the National Health Care program is completely in place.
As per Forest Gump --"Stupid is as stupid does."

Posted by: pahrumpete | July 22, 2010 3:43 AM | Report abuse

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