Tuesday, September 8, 2009

Health Care Reform Experiences by the States

In all the years that Congress has been debating some kind of health care reform, some of the states have tried their own hand at the matter. Let's look at a few of them.

Massachusetts has made a high-profile attempt at universal coverage. It's approach has been praised by both sides, but their experience has been that controlling costs required reducing payments to hospitals (sometimes not even covering operating costs) and excluding some who had been initially offered coverage. And the costs really haven't been controlled. In the end, I don't think it can be viewed as a viable model for a national reform to follow.

Maine has faired no better. It tried to save money by cutting payments to doctors and hospitals. It expanded its Medicaid rolls to twice the national average, but it's "public option" is so expensive low income residents can't afford it. A healthy, single, 30-year-old male in Maine pays almost 3.5 times as much for insurance in Maine as he would in New Hampshire. Premiums have increased 74%. Now new enrollment has been capped; there's a waiting list to get into the public option. Verdict? Train wreck.

Washington's example isn't a government run option; its Group Health Cooperative has been floated as a model for nation-wide co-ops. The co-op runs its own medical centers and employs the doctors; it pays them salaries instead of fee per service. It focuses on keeping patients healthy rather than treating illnesses. And premiums went up 9.7% last year and 13% again this year. Not exactly a great model for cost containment.

Oregon? They have repeated examples of the state health system declining curative treatment but helpfully offering physician-assisted suicide. 'Nuf said.

Other states have different experiences, but so far I haven't heard of any having any real luck at cost control. Universal coverage has proven to be impossible to achieve and prohibitively expensive to even approach. Does that mean we should just give up?

Has no one in the whole world come up with any solutions? We'll look at some other countries tomorrow.

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