Massachusetts: The Canary in the Coal Mine for ObamaCare

Five years ago, Massachusetts adopted its “universal health care” plan, which served as the template for President Obama’s subsequent national health care legislation. However, Massachusetts’ problems of rising health costs and worsening access foreshadow similar problems for the rest of America — as well as how to avoid them.

The Massachusetts Medical Society recently reported that the state law has resulted in “longer patient wait times [and] continued difficult access to primary care physicians.” The average wait time in Massachusetts to see an internal medicine physician is now 48 days — double the national average. Over half of primary care practices are no longer accepting new patients. Fewer physicians are accepting the state-run Commonwealth Care and Commonwealth Choice insurance plans. So although Massachusetts politicians frequently boast that they have increased “coverage,” many patients cannot find doctors to provide them with actual medical care.

Meanwhile health costs continue to skyrocket out of control, both for the state government and for privately insured patients. In a recent Forbes article, Sally Pipes notes that over the next 10 years, the plan will cost the state government $2 billion more than predicted. Similarly, prior to the new law insurance prices in Massachusetts increased at a rate 3.7% slower than the national average; after the “reform,” they’re increasing 5.8% faster.

To cut costs, Massachusetts Governor Deval Patrick has proposed replacing the standard payment system with draconian “global budgets” where doctors and hospitals would be given a fixed amount to care for the patients assigned to them. The providers would then keep a portion of the savings if they came under budget (or suffer penalties if they ran over budget) — thus creating morally perverse incentives to deny care to their patients.

The access problems have gotten so bad that the state legislature even considered forcing doctors to accept government-controlled insurance rates as a condition of retaining their state medical licenses (regardless of whether or not the doctors lost money on each patient). As Massachusetts-based health policy analyst Jared Rhoads describes it, this would be responding to the failures created by the government’s insurance mandate by imposing a new “physician mandate.”

Given this hostile practice climate, it is no wonder that many Massachusetts physicians are considering opting out of the government-run system into “concierge practices” — or leaving the state altogether. Dr. Lorraine Schratz, a Massachusetts pediatric cardiologist, noted that half of physicians trained in the state are leaving due to the poor practice environment and poor reimbursements.

Because the ObamaCare national health plan is closely modeled after the Massachusetts plan, we are beginning to see early signs of similar problems developing nationally.

One of the ways ObamaCare will attempt to expand “coverage” will be via dramatically expanding the Medicaid program. But as Medicaid patient Nicole Dardeau recently told the New York Times, “My Medicaid card is useless for me right now.... It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.” New Orleans ER physician James Aiken similarly noted, “Having a Medicaid card in no way assures access to care.” Once again, politicians can promise theoretical “coverage,” but this is not the same as actual medical care.