ObamaCare: A National Version of RomneyCare

The details of Congress' health care "reform" legislation are finally coming into focus, and it's not a pretty picture. Congress is essentially proposing a national version of the failing Massachusetts system.

In 2006, Massachusetts adopted a health care plan which included an individual mandate requiring residents to purchase state-approved health insurance, new regulations on insurance companies specifying who they must cover and what benefits they must provide, and a government-subsidized "public option" for low-income residents. Supporters promised a utopia of "universal coverage" which would save money while improving quality of care. However, the exact opposite has occurred -- health costs in Massachusetts have skyrocketed, while patient care has suffered.

Before we adopt a similar plan at the national level, Americans should know three things about the Massachusetts plan.

1) Massachusetts' system of mandatory insurance drives up costs and violates individual rights.

Under any system of mandatory insurance, the government must necessarily specify what constitutes an "acceptable" insurance plan. Hence, this creates a giant magnet for special interest groups seeking to have their pet benefits included in the required package.

Massachusetts residents are thus required to purchase benefits they may neither need nor want, such as in vitro fertilization, chiropractor services, and autism treatment -- raising insurance costs for everyone to reward a few with sufficient political "pull." In aggregate, such mandated benefits have increased the costs of health insurance in Massachusetts by up to 50%.

Since 2006, providers have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug-abuse treatment), and the state legislature is considering 70 more. In the past three years, insurance premiums in Massachusetts have increased by 8-10% each year, nearly twice the national average.

Mandatory insurance thus violates the individual's right to spend his own money according to his judgment for his benefit. Instead, he much choose from a limited set of insurance plans on terms set by lobbyists and bureaucrats, rather than based on a rational assessment of his needs.

2) "Coverage" is not the same as actual medical care.

Supporters of the Massachusetts plan frequently claim that it is a success because 98% of the state's residents are now "covered." But this is misleading, because it conflates theoretical "coverage" with actual medical care. In fact, access to medical care has worsened for many Massachusetts residents.

Because the state-mandated health insurance is so expensive, the government must subsidize the costs for lower-income residents. In response, the state government has cut payments to doctors and hospitals. With such poor reimbursements, physicians have become increasingly reluctant to see new patients.

The Massachusetts Medical Society reports that 40% of family practice doctors and 56% of internal medicine physicians no longer accept new patients -- "the highest percentages of primary care practices closed to new patients ... ever recorded."

Some patients in western Massachusetts must wait more than a year for a routine physical exam. Some desperate patients have even resorted to "group appointments," where the doctor sees several patients at once (without the privacy necessary to allow the physician to remove the patient's clothing and perform a proper physical exam).

Similarly, the average waiting time in Boston to see a specialist has increased to seven weeks. In contrast, waiting times in comparable cities in other states have been decreasing and now average three weeks.

Massachusetts patients may have theoretical "coverage," but that's not the same as actual medical care.

3) The Massachusetts plan will end in rationing.

Although supporters of the Massachusetts plan had hoped it would save money, the opposite has occurred. The state expects to spend $595 million more in 2009 on its health insurance program than it did in 2006 -- a 42% increase.

In response, a special state commission has proposed controlling costs by radically restructuring how doctors and hospitals will be paid. Instead of paying providers based on the services they render, the state would pay a fixed annual fee to cover all of a patient's medical needs. In theory, this would give providers an incentive to improve efficiency and eliminate unnecessary tests and treatments.

But in practice, this would also create a dangerous incentive for physicians and hospitals to render as little care as possible. Under the Massachusetts proposal, if your care costs less than your annual allotment, then the providers would keep the unused portion. If your care costs more, then the difference would come out of their pockets. Such a system thus pits your doctor's interests against your own.

Suppose your annual allotment was $5,000 and you had already spent $4,500 that year. You then see your doctor for a severe headache. He examines you and says, "No, Bill, you don't need a $1000 MRI scan of your brain. Just take two Tylenol and call me in the morning."

Can you be 100% sure that he's giving you unbiased medical advice?

And even if your doctor conscientiously practices in your best interest, he will inevitably find himself at odds with hospital administrators questioning his decisions:

"Does Mr. Jones really need another ultrasound test? Can't you use a cheaper antibiotic for his infection? Isn't his heart rhythm stable enough to allow sending him home today, rather than requiring another expensive night in the hospital?"

Your doctor will thus be forced to constantly balance your interests against the demands of a hospital administrator who might be deciding whether or not to renew his practice privileges.

Advocates of government-run health care like to claim that it is morally superior because it "doesn't put a price on human life." But when the government sets an annual spending cap for each patient, then that's exactly what it will be doing.

Such rationing is the dead end of the Massachusetts plan, and it will be the dead end of ObamaCare.

In summary, the Massachusetts plan has raised costs, reduced access to actual care, and will result in rationing. Americans should reject Congress' plan to impose a similar system at the national level. Otherwise, we'll be giving the federal government control over our lives (and one-sixth of the American economy), in exchange for a mere illusion of "coverage."

Or to paraphrase Benjamin Franklin, those who surrender essential liberty for temporary "universal" health care deserve neither liberty nor health care.