In 2006, then Governor Mitt Romney enacted health care reform in Massachusetts. What we have in Massachusetts is the foundation for what became the national health care reform President Obama enacted in 2010. That doesn’t mean what Massachusetts now have is similar to what will eventually happen in other states – the federal legislation passed by Obama means that each state will choose what kind of system works for them. Several states, such as Montana and Vermont, have suggested they will simply implement a single-payer, government subsidized system for all residents, and in low population states like those there’s good reason to think that will be cheaper for them in the long run. But in Massachusetts we have a private-public hybrid health care system. I’m here to analyze what’s working about that system, and what’s not, from the perspective of a provider (I’m a mental health therapist) and a patient. I currently have health care through my employer.
1. Most people have health insurance. 98% of the people in this state have health insurance: An astonishing, impressive stat. Let that sink in a minute.
2. People no longer have to worry about health insurance if they lose their job, become disabled, or their employer drops their coverage. There are several safety nets in place – unemployment insurance offers health insurance, the state system (Mass Health/Commonwealth Care) offers health insurance through the exchange. People can either buy health insurance on their own, or their employers can buy for their employees at a lower rate.
3. Kudos to Massachusetts, home of 68 different colleges, for forcing the colleges to provide comprehensive health insurance to their students, rather than all those students being dumped on the state system. And the rule that allows people to stay on their parents’ health insurance until they are 26 has been a huge relief to many people.
What’s not working:
1. The system is confusing. Half the time, the people on the other end of the phone when you call with questions don’t know the answers. The other half of the time they make you wait upwards of an hour just to talk to them. People are anxious when they can’t access their doctors, and people are unemployed. There is no reason why we can’t hire more people and train them well to be able to walk people through the system.
2. The system is inefficient. Why can’t people apply for health insurance online? Why do people, in 2012, need to fill out a paper application and submit it by mail, which can get lost, or take weeks or months to process? That is ridiculous. If we can have electronic medical records for health care, and we do, there is no reason in the world why we can’t have a more streamlined, online system for applying for health insurance when you lose it or move to Massachusetts.
3. Costs are still out of control. As in, because our health is still being managed by private companies who want to make money, they are doing everything they can to jack up costs for doctors, hospitals, and consumers. The Massachusetts Attorney General’s office and governor Deval Patrick are already working on this, but change is not coming fast enough. Massachusetts has more regulation than the only other state with a health insurance exchange already set up (Utah) and that’s good – but it needs more tightening up. Because they only ethical way to have health insurance managed by private companies is to regulate the hell out of them – because they don’t really care about you. They just don’t. Insurance company CEO salaries need to be capped, rates for different procedures need to be the same wherever you go, preventative and holistic care need to be reimbursed more.
4. Finally, the biggest problem I see is that still there are people who fall through the cracks. Right now, the people I see falling through the cracks the most are students whose parents don’t have employer-subsidized insurance and yet make too much money to qualify for Mass Health, and elderly people who qualify for federally-funded Medicare but then get dumped by state-funded Mass Health. Since Medicare doesn’t include as comprehensive coverage, this winds up putting our most elderly and disabled residents at risk. What happens is they get tossed around like hotcakes from the federal system, the state system, and private companies trying to determine who “has” to pay for their care. Often they get dumped into “Health Safety Net” – a woefully underfunded, overused network of community health centers that get money to serve people who can’t be seen anywhere else, because the insurance companies have said they won’t. The community center for my neighborhood, Joseph Smith Center, has one therapist on staff. How likely do you think you are to get seen quickly and comprehensively when you are one of hundreds of patients that one therapist is trying to see? Why isn’t there money to hire more people at these health centers, and why can’t those people qualify for any other coverage? The people I’ve seen get dumped into this pool include a 19-year-old daughter of a day care worker, supporting a family of four on one income, and a 50-year-old disabled woman who makes just under $15K a year in Social Security. Really? This is how low we’ve set our bar for who qualifies as “poverty level” in this country – these people are excluded.
So, in conclusion, Massachusetts has taken the brave step of being the first state to implement massive health care reform, and it’s had some tremendous positive effects. But the system still needs addressing. I call on states all across the country, as they look to fulfill the federal mandate to supply their residents with health insurance by 2014, to convene panels of citizens from their states, who either suffer without health insurance, or who have struggled with problems with their health insurance. Make decisions about policy after listening to the people, not the shareholders. The Massachusetts Attorney General’s office should begin hearings in every city in this commonwealth to allow citizens to report their concerns about how the system is working so far.