Five years ago, Massachusetts adopted its “universal health care” plan, which served as the template for President Obama’s subsequent national health care legislation. However, Massachusetts’ problems of rising health costs and worsening access foreshadow similar problems for the rest of America — as well as how to avoid them.
The Massachusetts Medical Society recently reported that the state law has resulted in “longer patient wait times [and] continued difficult access to primary care physicians.” The average wait time in Massachusetts to see an internal medicine physician is now 48 days — double the national average. Over half of primary care practices are no longer accepting new patients. Fewer physicians are accepting the state-run Commonwealth Care and Commonwealth Choice insurance plans. So although Massachusetts politicians frequently boast that they have increased “coverage,” many patients cannot find doctors to provide them with actual medical care.
Meanwhile health costs continue to skyrocket out of control, both for the state government and for privately insured patients. In a recent Forbes article, Sally Pipes notes that over the next 10 years, the plan will cost the state government $2 billion more than predicted. Similarly, prior to the new law insurance prices in Massachusetts increased at a rate 3.7% slower than the national average; after the “reform,” they’re increasing 5.8% faster.
To cut costs, Massachusetts Governor Deval Patrick has proposed replacing the standard payment system with draconian “global budgets” where doctors and hospitals would be given a fixed amount to care for the patients assigned to them. The providers would then keep a portion of the savings if they came under budget (or suffer penalties if they ran over budget) — thus creating morally perverse incentives to deny care to their patients.
The access problems have gotten so bad that the state legislature even considered forcing doctors to accept government-controlled insurance rates as a condition of retaining their state medical licenses (regardless of whether or not the doctors lost money on each patient). As Massachusetts-based health policy analyst Jared Rhoads describes it, this would be responding to the failures created by the government’s insurance mandate by imposing a new “physician mandate.”
Given this hostile practice climate, it is no wonder that many Massachusetts physicians are considering opting out of the government-run system into “concierge practices” — or leaving the state altogether. Dr. Lorraine Schratz, a Massachusetts pediatric cardiologist, noted that half of physicians trained in the state are leaving due to the poor practice environment and poor reimbursements.
Because the ObamaCare national health plan is closely modeled after the Massachusetts plan, we are beginning to see early signs of similar problems developing nationally.
One of the ways ObamaCare will attempt to expand “coverage” will be via dramatically expanding the Medicaid program. But as Medicaid patient Nicole Dardeau recently told the New York Times, “My Medicaid card is useless for me right now…. It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.” New Orleans ER physician James Aiken similarly noted, “Having a Medicaid card in no way assures access to care.” Once again, politicians can promise theoretical “coverage,” but this is not the same as actual medical care.
Like in Massachusetts, the Obama administration plans on controlling rising medical costs nationwide through a system of “bundled payments” to “Accountable Care Organizations” that would essentially reward doctors and hospitals for limiting care. Although the buzzwords may be new, one patient astutely observed to New York Times medical writer Dr. Pauline Chen, “Whatever that care plan is called, it still sounds like an H.M.O. to me.”
Hence, it is no surprise that many doctors are increasingly seeking to opt out of government programs such as Medicare. Others are moving towards “concierge practices” that allow them to practice according to their best medical conscience free from the restrictions of the government-controlled insurance system. And just as many fed-up Massachusetts doctors are leaving that state, some fed-up American doctors may start taking a closer look at overseas “medical tourism” practice opportunities.
In a recent Washington Post piece, Dr. Manoj Jain reported on his visit to a medical tourism facility in Bangalore, India. This facility catered to Americans by offering surgeries of comparable quality to American hospitals, in a clean, modern, high-tech setting — but at one-tenth the price. Similar facilities will be opening soon in the Cayman Islands, a mere hour’s flight from Miami.
Of course, under ObamaCare not every American doctor will relocate to another country. But as government controls increase, those doctors who most value their freedom to practice according to their best independent judgment will be least willing to be compelled to practice according to government “clinical guidelines.”
America may thus experience a combined internal and external exodus of the best, most independent, most conscientious doctors out of the government-controlled system — akin to how the best scientists, musicians, and artists fled the Eastern Bloc countries for the West during the Cold War. The remaining doctors will be the ones more willing to abdicate their professional responsibility to offer their patients their best independent expertise and instead practice “cookie cutter” medicine as dictated by bureaucrats in Washington, D.C. Is this the kind of doctor you will want caring for you five years from now when you are seriously ill?
Fortunately, it’s not too late for the rest of America to learn from Massachusetts. Instead of adopting that failed system at the national level, Americans should demand that Congress “defund” and repeal ObamaCare — and adopt genuine free-market health care reforms like those advocated by Tea Party physician-activist Dr. Milton Wolf and Whole Foods CEO John Mackey. Such reforms include fixing the tax code to put employer-provided health insurance and individually-owned health insurance on a level playing field, repealing costly mandates specifying which benefits insurers must offer, allowing individuals to purchase health insurance across state lines, and eliminating monopolistic medical licensing requirements that prevent doctors from practicing across state lines. These reforms would lower costs and improve access to quality medical care, while respecting the individual rights of patients, doctors, and insurers.
The ongoing failure of the “universal health care” plan in Massachusetts serves as a clear warning to the rest of America. The only question is whether we’ll heed it.
Paul Hsieh, MD, practices in the south Denver metro area. He is co-founder of Freedom and Individual Rights in Medicine (MD).
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