The Massachusetts House and Senate are having a
difficult time agreeing on the terms of a health-care reform bill.
The federal government has given us a deadline to improve health
insurance coverage or lose $385 million in federal Medicaid money. Gov.
Mitt Romney created a proposal to expand the number of insured here, the
House and Senate passed different versions of the bill, and they are all
now trying to work out their differences.
I'm not overly concerned about the $385 million. Since the Legislature
refuses to do the income-tax rollback, none of that federal money will
be mine, anyhow. So I figure the commonwealth's loss is the federal
deficit's gain to the benefit of my grandchildren.
I've been supportive of health-care reform primarily because the present
situation is unfair and untenable: Those employers and citizens who pay
increasingly high premiums for their health insurance must also, through
the state's mismanaged "free care" pool, pay for treatment for the
uninsured. This treatment often takes place in emergency rooms instead
of being part of the preventative medicine program that comes with
As David King, director of communications at North Shore Medical Center,
explains, "We are already paying for those without insurance, giving the
most amount of money for the least amount of care."
He was part of a panel I heard at a Salem Chamber of Commerce forum this
week discussing the various "health-care reform" proposals. Other
panelists were Dr. Jon Kingsdale, senior vice president at Tufts Health
Plan, Michael Widmer of the so-called Massachusetts Taxpayers Foundation
(MTF), and two local state representatives, John Keenan, D-Salem, and
Mary Grant, D-Beverly.
Though I went hoping to find a sensible solution, I admit to certain
prejudices toward the participants. Tufts HMO is Citizens for Limited
Taxation's insurance company, and while premiums are painful for a
little taxpayer group, we get excellent service. Since I hate driving
into Boston, I'm a North Shore Medical system customer. But MTF is my
longtime adversary on tax issues, and I don't have much confidence in
the Legislature in general.
However, MTF for a change shared my concern about higher taxes — in this
case the House version's job-killing new payroll tax.
However, MTF's alternate plan is a state subsidy for more coverage,
phasing in $200 million a year for the next three years for a total of
$600 million. Romney has already placed that first $200 million in his
Let's use the traditional rule of thumb for any new government program:
It will cost three times what they say it will. Or how about the new Big
Dig rule of thumb: It will cost seven times the original estimate.
All the panelists seemed to agree on the problems: high costs for
ever-advancing treatments; high consumer expectations; the fact that the
uninsured are presently treated in the most expensive, least effective
emergency room environment; and inadequate reimbursement for the
hospitals that provide it.
It wasn't until the legislators spoke, though, that I decided we might
be better off just doing nothing — that maybe we should celebrate the
gridlock on the bills.
One person in the audience asked if this issue might not be too big for
a state to handle on its own, suggesting that a solution must come at
the national level.
Grant had already made her pitch for "a single-payer system" like those
in Europe and Canada. Keenan argued that the states are supposed to
experiment and come up with solutions that can then be expanded
Wonderful. Let's "experiment" with Massachusetts. Then when our economy
is a train wreck and half the population has died prematurely from
government-run health care, the rest of the states will know what not to
Just kidding. No one at this point is seriously arguing for state-run
health care here. But if Massachusetts expands coverage, won't this
encourage people — from other states, and those here illegally from
other countries — to come here for the subsidized insurance? And with
more state involvement, can we really expect better management than we
are currently getting from the "free care" system that our inspector
general has criticized?
King from North Shore Medical mentioned the debate between personal
responsibility and a government role, between employer and employee
funding. At the federal level, my preferred solution would let
individuals buy their own insurance with pretax dollars and carry it
from job to job. But at our state level, the phrase "personal
responsibility" doesn't usually compute. This is the state that
presently charges self-payers in nursing homes $10.99 a day (that's over
$4,000 a year) as a "fee" to support Medicaid patients.
That's right, we tax the sick elderly citizens who planned ahead to be
personally responsible and use them to rip off the federal government
and its taxpayers. As the self-payers use up their own funds faster,
they move onto the Medicaid system, half of which is reimbursed by the
feds. Doesn't this contradict the federal goal of fewer people on
Medicaid, which is the reason for the present health-care debate?
My final thoughts for now on the subject: First, do no harm. Then repeal
the nursing home tax. Then let's talk some more.
Barbara Anderson is executive director of Citizens for Limited Taxation. Her syndicated columns appear weekly in the Salem
News, Newburyport Times, Gloucester Times, (Lawrence) Eagle-Tribune, and Lowell Sun; bi-weekly in the Tinytown Gazette; and occasionally in the Providence
Journal and other newspapers.