A probably unwelcome thank you

[docorion]

I would like to take a moment, on the 5th anniversary of chapter 58 of the Acts of 2006 (better known as the Massachusetts health reform law) to thank some of the people responsible for making it happen. (Some of these are people I know personally, having interviewed them for a paper in graduate school. Some, like Mitt, I know only by reputation

Comments

[docorion]

More (most) people have at least some form of insurance; all insurance must cover at least 3 PCP visits annually, and a raft of screening. If you don't have insurance because you can't afford it, filling out a (long, complex) form will often get it for you. If you don't, your costs are often underwritten by the state through a mechanism which in part involves a tax on people who refuse, for one reason or another, to purchase insurance (short form: if you cannot prove you had "credible coverage" for most of the year, you are subject to a tax penalty which is based on the cheapest form of insurance you could have purchased had you chosen to do so) and in part involves a tax on businesses which do not provide coverage despite the law requiring they do so (and the rest involves spending state general revenue, but honestly it isn't that much).

Individuals (like me) can access insurance which is underwritten at community rates, instead of individual rates (individual rating-pricing insurance based on *your personal* health history-is prohibited in MA; all insurance is community rated, meaning the premium is based on the pool of people like you (mostly having to do with age; gender is also prohibited as a discriminator. The effect of age is, I trust, obvious; the effect of gender is less obvious unless you know that as a group, women "consume" more health care than men. Why that is so is a subject of lively debate. Film at 11).

Long-term effects are long-term (read: 20-30 years). Effects on health won't be seen for a while, assuming there are any (public health fact number one: very little of the health of a population depends on what medical professionals do, or don't do. Firing all of us and replacing us with robots will make people insecure, but if you then spend all of that money on things known to public health professionals to improve the health of the public, the numbers would reflect either no change, or more likely a small to moderate improvement. (OK, that may be unfair, but we are expensive for the effect we have on actual health statistics)). On the national stage, chapter 58 was the model for the Affordable Care Act. More importantly, from my point of view, it pulled the business of health care (the fact that it's fee for service all through, and has no mechanism for finding out how much, if any, good any of it does) off its pedestal, and made Jane/Joe in the Street start thinking about the fact that, you know, they really didn't know what they were buying when they went to the doctor, and maybe they ought to.

It's very, very messy. The optimist in me thinks we will, in the end, have a better, stronger health system. The pessimist in me says that we will have that only because we will try every other system first, to make sure it doesn't work. We're an example to the world, we are...

[likethewatch]

Is there really debate on why women consume more health care? I would think the answer is obviously that their reproductive health is more complicated than men's.

[docorion]

Well, that's a factor, but even if you control for that, women consume more health care. Women visit doctors more often, get more tests and procedures, and are prescribed more pharmaceuticals, than men, across the spectrum of disease. Until recently, insurance companies controlled for that by jacking up the premiums for women; chapter 58 put an end to that.