Massachusetts Gov. Deval Patrick shamelessly boasted about his state's mandated exchange-based health insurance program at the Association of Health Care Journalists conference this month in Boston.
Six years into the program, some 98 percent of Massachusetts residents have health insurance, more than 90 percent have a primary care doctor that four of five have seen in the past year, 150,000 have quit smoking, emergency room visits are down, he said, and health screenings have saved lives, including a 30 percent drop in cervical cancer alone.
“For us, health is a public good,” Patrick said.
Spurred by the instantly likable Patrick, I was awed and inspired by the successful statistics. But journalistic objectivity — or healthy temperance — returned, when I was reminded by friends in Boston, and subsequent panelists at the conference, that the way stats are presented can be misleading.
Ninety-five percent of Massachusetts residents already had health care before Romneycare, my friends told me. And though rates for individuals have come down, rates for small businesses have shot up, they said, along with costs associated with additional mandated benefits.
After spending tens of millions on advertising, including on the Jumbotron at Red Sox and Celtics games, The Massachusetts' exchange covers only 4,600 lives in the small business market — compared with projections of 300,000, said Josh Archambault of the Boston-based Pioneer Institute. And while more companies, some 76 percent, are offering insurance, fewer employees are taking it — 50 percent in 2011, down from 67 percent in 2001, he said.
Over the last four years, the Commonwealth has seen an 8 percent increase in the number of companies moving to self-insured plans, where they, though assuming more risk, can avoid many government mandates, Archambault said. Some 55 percent now are self-insured, he said. Meanwhile, The New York Times recently reported healthier companies with as few as 10 to 20 employees are considering the move, with the key mandates for federal health care reform looming Jan. 1.
Columbia Journalism Review blogger Trudy Lieberman urged colleagues to report on the National Federation of Independent Businesses' protest of Obamacare's tax on insurance companies. NFIB fears the tax — which is expected to raise some $87 billion over 10 years to pay for the subsidies for the uninsured — will be passed onto small businesses in the form of higher premiums for their workers.
Jonathan Gruber, an economic professor at the Massachusetts Institute of Technology, and other presenters wholeheartedly support the Massachusetts and federal reforms. If built correctly, exchanges can pay for themselves, said Gruber, adding that states, like Florida (and Oklahoma), that choose not to expand Medicaid are doing a “massive disservice” to those who live below the poverty line and will have no other recourse for accessing health care, or some 1.3 million Floridians. Gruber believes states ultimately will choose to take the federal money because it's a “huge stimulus.”
Donald Berwick, a Boston pediatrician and former administrator of the Centers for Medicare and Medicaid Services, said the country must move from its low-value, high-cost, fee-for-service system to one that emphasizes good health outcomes.
“We have to change the way we think; we don't get more when we pay more,” said Berwick, who referenced the website choosingwisely.org and a health care project in Alaska, where team-based care has resulted in 50 percent fewer hospital bed days, 53 percent fewer emergency department admissions and 65 percent fewer specialty visits.
Meanwhile, Gov. Patrick, making similar arguments, vows “Massachusetts will be the place that cracks the code on cost containment.” The governor in August signed a cost-containment bill estimated to save $200 billion in health care costs over the next 15 years. The state's goal this year and next is to hold increases in health care spending to 3.6 percent, or no more than the growth in the state's economy.
Ultimately, it may come down to individuals to collectively make the difference. Depending on whether we choose the latest technology or lean toward natural healing, are doubters or believers, minimalists or maximalists, each of us has a highly individual approach to weighing the risks and benefits of treatment, I learned from spouses Jerome Groopman and Pamela Hartzband, doctors with Harvard Medical School and authors of “Your Medical Mind: How to Decide What is Right for You.”
For example, though best-practice guidelines may call for cholesterol-lowering medication in patients with levels 200 or more, individuals may opt for no meds and doctors, under health reform, consequently may be publicly rated as not meeting outcomes.
Moreover, when it comes to end-of-life issues, individuals can't effectively forecast what they'll choose until they've experienced it, the author-researchers found. Prostate cancer sufferers, for example, might predict they'd rather die than live so many years with incontinence and/or impotence but, if and when they're diagnosed, choose treatment and the associated risks.
Plagued with a backache my entire week at the conference, I, for one, am a maximalist — when it comes to treating pain anyway. I pounced on the meds my twin sister, who lives in a Boston suburb, generously shared with me.
Back home, I promptly paid a visit to my internist to, among other things, request a prescription for muscle relaxers so I — hopefully — can head off any future back spasms. I have yet to meet my annual out-of-pocket deductible, but didn‘t give much thought, if any, to the costs I personally am helping run up.