Obamacare, Massachusetts plan make mockery of 'reform'

WASHINGTON — If you want a preview of President Barack Obama's health care "reform," take a look at Massachusetts. In 2006, it enacted a "reform" that became a model for Obama. What's happened since isn't encouraging. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people's health. Unfortunately, Obama has done the same.

Like Obama, Massachusetts requires most individuals to have health insurance (the "individual mandate"). To aid middle-class families too well-off to qualify for Medicaid — government insurance for the poor — the state subsidizes insurance for people up to three times the federal poverty line (about $66,000 in 2008 for a family of four). Together, the mandate and subsidies have raised insurance coverage from 87.5 percent of the nonelderly population in 2006 to 95.2 percent in the fall of 2009, report Sharon Long and Karen Stockley of the Urban Institute.

People have more access to treatment, though changes are small. In 2006, 87 percent of the nonelderly had a "usual source of care," presumably a doctor or clinic, note Long and Stockley in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.

But much didn't change. Emergency rooms remain as crowded as ever; about a third of the nonelderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally — and most important — health costs continue to soar.

Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else — schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.