This is a month old but I just came across it. Former NEJM editor Marcia Angell explains why the Massachusetts health care reform legislation, on which Barack Obama's national proposal is largely modeled, doesn't work. As I've said here many times, it does nothing to contain costs, forces low and moderate income people to buy insurance they can't afford, and will bankrupt the state before it achieves universal coverage.
A couple of quotes, but read it, okay? On the Massachusetts experience:
While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll. The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because -- yes, that's right -- they couldn't afford it (so much for universality). The state modified its requirement that all insurance meet a minimum standard. Jon Kingsdale, the executive director of the Commonwealth Health Insurance Connector, told me that was because the federal Employee Retirement Income Security Act prohibits states from setting standards when employers act as their own insurers (didn't the Massachusetts legislators know that when they crafted the law?), but he said that next year workers will be responsible for somehow upgrading their own policies, or (you guessed it) be fined.
On the financial impact on individuals:
Although insurers are prohibited from charging more for people with medical conditions, older people have to pay more. The premiums for a 57-year-old are twice as much as for a 27-year-old. According to the Connector's Web site in March of this year, the least expensive plan for a 57-year-old had a premium of $4,700 per year, a $2,000 deductible, and substantial co-pays and co-insurance up to $4,000 per year. (That cap did not include prescription drugs.) So a hypothetical 57-year-old with a $32,000 annual income (just over three times the poverty level) could pay as much as $8,700 out of pocket -- or over a quarter of his income. Family plans are, of course, different, but the effect is the same. Next year, those who haven't purchased insurance will be fined half the premium of the lowest-priced plan. Truly this is the Squeeze Blood from a Turnip Plan.
So it's probably just as well that Obama doesn't want an individual mandate, but then what is to be gained?
We need universal, comprehensive, single payer national health care. Period. Say it, Democrats. Don't be wimps.