The Wall Street Journal

Yes: Inclusive Health Care Is Expensive, but Just How Expensive?

Letters to the Editor

Jon Kingsdale accuses me of prematurely offering a negative prognosis for the Bay State's universal health care plan ("Bay State Insurance Is Doing Fine, Thanks," Letters, Feb. 7). Actually, he's the one in denial.

Mr. Kingsdale disputes my figures about the cost overruns for the subsidized portion. But the numbers are clear: This year, Massachusetts budgeted $472 million for this portion -- and spent $619 million. Next year, by Mr. Kingsdale's own account, the governor is seeking subsidies worth $869 million -- an 85% increase over this year's original budget, as I noted. What's more, the Boston Globe reported last week that the "annual costs for the subsidized insurance program at the heart of the (universal health care) initiative are projected to double over the next three years, reaching $1.35 billion by June 2011."

Mr. Kingsdale claims that Massachusetts's health-care reforms will moderate the 12 % annual premium increases that have plagued it -- like the rest of the country. Actually, the reverse is the case. Some years ago, a moderating trend began nearly everywhere except Massachusetts, precisely because its reforms have inflated health care demand and choked supply. If the state does join this trend, it won't be because of any efficiency gains, but aggressive price controls on insurers and providers, something that will inevitably invite health-care shortages and government rationing over time.

Mr. Kingsdale insists that uninsured couples in their 50s can obtain coverage for half of the $8,200 that I had claimed. But a search on CommonwealthConnector, his own Web site, fetched nothing less than $833.39 per month or $10,000.68 per year in annual premiums for 50-plus couples making over $40,000 and living in Middlesex or Suffolk counties. Co-pays and deductibles are extra. Mr. Kingsdale's claim would only pan out if federal and state tax breaks discounted these premiums by 60 % -- a virtual impossibility.

The preliminary results of Massachusetts's grand universal care experiment are not encouraging. Mr. Kingsdale does Bay State residents no favors by pretending otherwise.

Shikha Dalmia
Senior Analyst
Reason Foundation
Los Angeles


Bay State Insurance Is Doing Fine, Thanks
February 7, 2008; Page A17

In condemning Massachusetts's landmark effort to insure our citizens, Shikha Dalmia can't wait (for the facts) to render a verdict ("Saying No to CoerciveCare," op-ed, Jan. 31).

Ms. Dalmia claims that spending for our subsidized plan will cost 85% "more than originally projected" during the next fiscal year. The governor's budget proposal calls for $869 million. The original estimate by the conference committee that wrote the legislation in 2006 pegged it at $725 million. That's 20%, not 85%.

She claims that inflated demand combined with onerous regulations triggered premium increases of 12% this year. In fact, premiums had been rising 12% or so prior to reform, but we are expecting that trend to moderate under reform. As of July 1, 2007, the typical uninsured individual in Massachusetts could buy a policy that covered twice as much for half the premium as that person could have bought before reform. Just one example of how we are helping control costs, not increase them.

She claims that the cheapest plan available to a couple in their 50s is $8,200. It's actually much less and when the couple takes advantage of reform to buy it with pre-tax dollars, the price is nearer to one-half of Ms. Dalmia's $8,200 assertion.

Across the country, more and more people are going without health insurance every day. In just 18 months, Massachusetts has newly enrolled over 300,000. Now there's a fact. And better yet, this one is true.

Jon Kingsdale
Executive Director
Commonwealth Health Insurance Connector Authority
Boston

Shikha Dalmia's strong objection to the inclusion of an individual mandate in the Massachusetts health-care reform law reflects her opinion on a point of policy ("Saying No to CoerciveCare," op-ed, Jan. 31). However, her assertions that Massachusetts's neighborhood health centers are "ill-equipped to treat anything beyond routine ailments" and provide "substandard care" reveal a fundamental lack of knowledge about community-based health centers and the care they deliver.

Board certified physicians, trained at some of the country's most renowned medical schools, are on the staff of many Massachusetts neighborhood health centers. Our health centers undergo rigorous national accreditation, and our quality and performance standards are nationally recognized for reducing hospital emergency room visits and admissions and improving patient health.

Patients receive medical, dental, behavioral health care and chronic disease management at their neighborhood health centers. Based on a host of readily available studies, there is no clinical condition seen in a hospital primary care practice that cannot be managed as well -- or better -- in a neighborhood health center.

Massachusetts's health centers have demonstrated time and time again their ability to improve patient health outcomes, lower the incidence of chronic disease and disability, and reduce demand on every level of our health-care system -- thus decreasing the overall costs of care. As the health-care price tag becomes an increasingly critical issue for our country, we expect that more people will recognize the value that our community health center network brings to the table.

James W. Hunt, Jr.
President & CEO
Massachusetts League of Community Health Centers
Boston

Shikha Dalmia is Senior Analyst





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