The Massachusetts Model

On June 16th the NY Times had an editorial entitled "The Massachusetts Model" about how the Massachusetts healthcare plan is progressing. (click link to see the editorial).

I think that the editorial misses the most important objective of healthcare reform: improving the health of the United States population in an efficient and affordable manner. In this respect the Massachusetts plan is unproven or even failing. Like most healthcare reform proposals, the Massachusetts plan aims to achieve universal coverage by expanding either commercial or publicly financed insurance to cover more people. There is little concern about what that coverage actually covers or acknowledgement that different insurance plans offer widely different quality of health care.
This is the reason why the editorial observed that "many of the newly insured reported difficulty finding a primary care physician, and the share of low-income residents using emergency rooms for nonemergency care rose slightly, the opposite of what was supposed to happen." The fact is that Medicaid, the insurance for the poor, is not the same as Medicare or commercial insurance when it comes to paying the provider. For an outpatient consult Medicaid pays less than 20% of the average commercial insurance and 1/3 of Medicare. Since most primary care physicians have staggering levels of overhead and very little "profit margins" in their practice, they cannot afford to take these newly insured patients into their practice. Instead the Medicaid patient continues to use community based clinics or the hospital emergency rooms. This, in turn, provides these patients with lesser or even substandard medical care and still ends up costing more.
Even if the Massachusetts plan is able to reach its goal of universal coverage, it is unlikely that they will be able to show better outcomes for its enrollees. The most effective solutions for health care reform are those that will be able to cover the entire population equally for the most important forms of healthcare; namely, life saving and life extending conditions as well as preventive care. This will require a healthcare system that is predicated on affordable evidenced-based proven therapies available to everyone on an equal basis.
Gil