States Show How Not To Fix Health Care
By KERRI HOUSTON TOLOCZKO
Since the debate over the government takeover of medical care exploded onto
the national stage, advocates of market-based, patient-centered reforms have
pointed to the failed government health care systems of Canada and the U.K.
as examples of what America should not replicate.
And rightfully so. Democrat proposals have duplicated many components of
these systems, creating frighteningly similar base lines here to these
unsuccessful foreign models of "universal" coverage.
Yet we don't need to peer over borders and across oceans to find government
health care that does not work; indeed, we have examples here in our United
States.
Hawaii, Oregon, Massachusetts, Tennessee and Maine have all created some
version of government takeover or administration of health care, and all are
a mess.
Hawaii's Prepaid Healthcare Act and its coverage mandates have left
Hawaiians with fewer coverage choices, higher costs and nearly double the
number of uninsured. Recent budget cuts resulted in discontinuation of its
coverage for children.
Oregon's state-controlled care includes an official list that dictates what
treatments will be covered based on annual budget constraints. If your
disease is above the treatment line, you are covered. Below the line -
you're not.
However, patients being denied treatment often receive an additional note in
their denial letters - the system telling them it will pay for "physician
aid in dying." Oregon won't help you live, but it will help you die.
In the three years since the Massachusetts "universal" coverage plan was
launched, the state still has thousands of uninsured, costs have exploded to
unsustainable levels, and waiting lists for treatments have appeared.
Tennessee's "TennCare" program, an attempt to expand coverage to low-income
uninsured, included dead people, escaped felons and NBA stars. It drove
doctors and insurers out of the state, and has been on the brink of
insolvency several times.
Tennessee's Democrat governor, Phil Bredesen, recently went to Washington,
D.C., to explain to Congress that government health care does not lower
cost.
But perhaps the worst - and closest - example of why a federal takeover of
health care won't work comes from Maine.
The name of Maine's government-run universal health care plan "Dirigo
Health" is derived from the state's motto - "to lead." Fitting, as this
failed attempt at government health care has led its people right off a
cliff.
Maine's universal coverage plan is most similar to the plans circulating on
Capitol Hill. It was proposed in May 2003 by Democrat Gov. John Baldacci and
passed a scant four weeks later. Much like the $787 billion federal
"stimulus" plan that passed Congress in February of this year, nobody read
the Dirigo plan either.
While greasing the pipeline for quick passage of Dirigo Health, the governor
assured that all of Maine's 128,000 uninsured would be covered by 2009, the
bureaucracy would be streamlined and health costs lowered, and the plan
would fund itself based on system savings with no tax increases - a similar
claim to what President Obama has said about a new federal plan.
Six years after it was passed, it has insured only 3% - roughly 3,400 - of
the 128,000 promised.
By 2007, the system was so broke that it closed to new enrollees. It still
has not reopened and has also cut and capped benefits. The "streamlined"
bureaucracy has cost the state's taxpayers $17 million in administrative
costs to cover 9,600 people, leading one to wonder if there are more
bureaucrats in the system than enrollees.
Systemwide insurance costs have increased 74% since Dirigo was passed, and
the governor and legislature have tried - unsuccessfully - to raise taxes to
fund the system.
Dirigo's more "efficient" bureaucracy started out with an aggregator agency
for health records and a cost administration agency, but it now includes
numerous councils to study this, that and anything else bureaucrats can
conceive.
These agencies also dictate to providers how much they can spend on new
technologies and diagnostic machines even though these costs are borne by
physicians and hospitals and not the state.
Dirigo has failed because it lacks market forces, ignores the nature of the
uninsured and was more interested in bloating its bureaucracy than providing
care to patients.
These states could have fixed the broken pieces of the system by
implementing market-based, patient-centered reforms that bring people into
the private insurance market, thus lowering costs and increasing access.
Instead, they layered enormous bureaucracies over patients and physicians,
and separated them both from each other and from quality care.
Government intrusion is not reform. Congress must use the failures of
state-run health care as cautionary tales of change to avoid. It's time to
start pushing for real reforms that increase access and portability and,
above all, protect the primacy of the doctor-patient relationship.
. Houston Toloczko is senior vice president for policy at the Institute for
Liberty and director of its Center for Health Security and Access. |
