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To: Pogeu Mahone who wrote (163154)	11/10/2008 1:02:10 AM
From: patron_anejo_por_favor	Read Replies (3) \| Respond to of 306849

Mass isn't working because it's not national and they have too little leverage over providers. A national system won't have that (and it won't have sickees from neighboring states moving in to take advantage of the system). Obviously in the first year or two of coverage you're going to get higher utilization. If it remains a problem you kick copays up if the visits are found to be for generally inappropriate stuff (a little goes a long way with primary care visits) And you either initiate or raise ER copays. The point is, any change to a system like that will require adjustments until equillibrium is reached. That program is what, 16 months old? I'm sure the think tanks are pouring through the records to figure out whether a lot of folks can be seen at alternate levels of care to unclog the system. At least they should be. Don't they have "urgent care" centers in Massachusettes for example? If medical manpower is the issue, maybe the state needs to look at the way they treat doctors. Or subsidize training more.