THE TREATMENT DECEMBER 18, 2009
Today Markos Moulitsas (that's Kos, of DailyKos, for those of you have been living in a cave without internet access) adds to his brief against health care reform, at least as it's taking shape in the Senate. His latest piece of evidence is Massachusetts, where, he notes, overall health care costs have not come down three years after sweeping changes there.
He's right about that. And Ezra Klein offers what I would consider the right rejoinders. Chief among them: Massachusetts didn't even attempt to control overall costs; it simply wasn't part of the package. By contrast, the plans moving through Congress have multiple provisions to reduce what we spend on medical care. And quite a few respected experts believe those provisions will work, although there is surely plenty of room for disagreement (even among those experts) over which ones will work and how much effect, in the end, they will have.
But I want to focus on what Massachusetts did attempt: Expanding insurance coverage. Before the reforms, 10 percent residents had no insurance. And now? It's down to 3 percent. That is the lowest percentage of any state, by far.
Moulitsas addresses this issue near the end of his post. The problem, he says, is that the progress is phony. Citing figures that come from the Urban Institute, he notes that around a fifth of residents report forgoing needed care in the last year, for one reason or another. "So not only does a mandate-centric health 'reform' plan not control costs, but also continues to leave people it pretends to cover in the dust, too poor to afford steep co-pays and deductibles."
Again, Moulitsas has identified a real problem: Plenty of people of insured people in Massachusetts still struggle with medical bills. But there's a lot more to the story here.
That very same Urban Institute study suggests that, overall, reforms in Massachusetts have improved access to health care and eased the financial burden of medical bills. The percentage of people skipping care actually fell four percentage points in the first year, then remained stable despite an economy that reduced people's incomes. And that's just the beginning of the story, as I wrote about a few months ago in my own examination of Massachusetts:
According to a study that two Urban Institute researchers published this spring, the number of working-age adults reporting that they skipped care because of high costs fell from 17 percent to 11 percent in the first two years after the law took effect. The gap was even more dramatic among those eligible for subsidized insurance through the Connector--that is, people making less than three times the poverty line, or around $66,000 per year for a family of four. Among those people, the proportion skipping care because of cost fell from 27 percent to 17 percent. And that’s despite a rough leveling-off in the second year, most likely due to the fact that the recession meant lots of people were out of work and counting their pennies. When the economy rebounds, the number should decline even more.
Has reform solved the access problem in Massachuestts? No. Has it made the problem a lot less severe? Yes.
You can make the same argument--the exact same argument--about what's likely to happen if the Senate bill passes.
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