Tuesday, January 01, 2008

One Way to Pay for Mass Health Care...

Create exorbitant penalties! Woot! Now, not only have we failed to accomplish our goal (to get more people insured), but we're penalizing the people who can't really afford to buy it.
Penalties for Massachusetts residents who can afford health insurance but do not purchase it in 2008 could quadruple compared with the maximum penalty in 2007, according to draft regulations released by the Department of Revenue yesterday.
Call me cynical again, but I doubt it's a coincidence that we're facing a huge shortfall on the health care bill and the state is contemplating quadrupling next year's penalties for those who don't buy it. What better way to pay ourselves out of this mess than kicking people when they're down?

The question becomes, of course, what is Massachusetts going to do about health care costs? Using the current model, HMOs are only all-too-happy to provide "cheap" insurance options that are still too expensive for tens of thousands of residents. Furthermore, despite the great cost, the "cheap" options come at great expense: stratospheric deductibles, lousy care and a maximum payout of 50-100k, which isn't going to help much if someone comes down with something like cancer. (Not to mention annoying Blue Cross/Blue Shield commercials every 45 seconds.)

If the state is serious about fixing health care in Massachusetts, we can't wait to reform this mess. With slimy HMO tentacles smothering and clinging their every inch on our every attempt at health care reform, I'd say our current efforts at fixing the state's health care problems are quickly nearing FUBAR. The first thing I'd suggest the state do, instead of having a "personal mandate," is to create an actual mandate: create a public option. Then give people a choice - either they get private insurance or public insurance. For those who don't get private insurance, automatically sign them up for the public option - and create a fair rate given personal income. Also, make sure employers are paying their fair share when they don't offer private options. There. Done. Fixed.

We can create health care that people can afford - and that won't make this state go bankrupt. It shouldn't cost people who don't have insurance upwards of a thousand dollars a year, all the while continuing to prevent them from having affordable health care. That's the kind of policy that just doesn't make sense. But until we make Beacon Hill willing to take on employers and the health care lobby, nothing's going to get fixed and we'll continue to see scary headlines like today's: a New Year indeed.


Norma said...

The State has made being uninsured a CRIME and that is really disgusting!The citizens of Massachusetts are forced to buy bogus insurance with high as much as $6000.00 and when we don't buy in they fine us.How does DOR get mixed up with health insurance???This is the lunacy of Beacon Hill.

NoStonesUnturnedinMA said...

Health Care for All (not the group) but the Commonwealth's plan has been a misnomer in many ways. The Executive Office of Health and Human Services, by law, has a mandate to develop and implement a waiver to MassHealth with Medicaid. The premise is to overturn the heavy use of nursing homes and other long term facilities and provide care in the community. The premise is a sound one. The delay of getting this waiver off the ground, dating back into the Romney Administration has probably cost the tax payers millions in potential diversions from long term care or home based care. The calculation makes sense if one starts to examine the things folks just don't usually measure (family care giving, single parents taking care of their kids, the cost to society of folks being penalized for caring for their loved ones (having to leave work early or arrive late and perhaps losing a job).

The waiver was called Community First. The irony is that their are plenty of people in the community first (including those we're not penalizing to pay for insurance). If you want to go head hunting, look no further than our own Massachusetts HMOs. The cost of a private policy is thousands of dollars. The profits these companies make are incredible. Easy to simply reduce profits and sell cheaper policies. The Massachusetts Behavioral Partnership (MBHP) has an operating cost of millions, including very swank Boston Realestate to boot. Again, the cost of diverting these kinds of expenditures alone would result in monies for all Massachusetts residents. The Aging Service Access Points (an EOHHS agency) have not been recontracted in well over a decade, perhaps even fifteen years. This means the same monopoly holds the keys to elder care statewide. Check out the salaries of most of their directors. Check out the salaries of the line workers. Check out the cost differential in insurance for those working in human services. Most policies still end up with the poor worker (human services and non human services) paying over 25% of their health care premium.

If MassHealth would simply use real accountants, real health care economists and roll potential efficiencies back into the system, then one could actually watch and see the effect of any long term care program.

People need to read, speak-up and understand true universal health care would mean no premium or a scale that is genuinely indexed to a given John or Jane Doe's cost of living. This means if a home (if you can afford one in MA) or rent - costs you $1500 per month, plus your car, plus your children's school costs etc, then anyone with a family income of 75K or less is essentially a paycheck away from poverty. The affordable connector policies are not affordable at all (hundreds per month).

Look to government to be smart abotu it's own costs and one will find the $ to actually insure everyone. Go after the new telephones and chairs every couple years, the new computers, the blackberries, the meaningless Federal Grants that actually could have been used as $ for individuals (Anyone seen the System Transformation Grant?) (Anyone seen the ADRC Grant ) (Anyone know how many millions are coming in from SAMSHA for Alcohol prevention in the next year). Do you know what it means when the ASAPs of Elder Affairs haven't been effectively audited for years, to the tunes of hundreds of millions of dollars--YET this piece of the state's service structure only covers about 42,000 of our state's elders. Some swank digs for these agencies.

Ever call MassHealth---it's a fair thing to say that 50% of the folks you may reach on the phone are curt, overly concreate and that alone is a diversion to getting help.

Burned in the Uncommonwealth

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