OT What has been the effect of forced health insurance in Massachussetts?

I suggest two working papers authored jointly by Jonathan T. Kolstad of the= Univ. of Penn., The Wharton School and Amanda E. Kowalski of Yale Univ., D= ept. of Economics. The first was published in May, 2010 titled "Impact of H= ealth Care Reform on Hospital and Preventive Care: Evidence From Massachusr= tts". The second was published in March of this year titled "Mandate-Based = Health Reform and the Labor Market: Evidence From the Massachusetts Reform"= .

In the second paper, they conclude "Because individuals valued ESHI, mandat= e-based health reform in Massachusetts resulted in significantly less disto= rtion to the labor market than it would have otherwise. We estimate that if= the government had instead increased insurance coverage by establishing a = wage tax to pay for health insurance, the distortion to the labor market wo= uld have been more than 20 times as large. Our results suggest that mandate=

-based reform has the potential to be a very efficient approach for expandi= ng health insurance coverage nationally."

Both papers are readily available from the web.

Their paper were prepared for the NATIONAL BUREAU OF ECONOMIC RESEARCH in C= ambridge, MA.

he Univ. of Penn., The Wharton School and Amanda E. Kowalski of Yale Univ.,= Dept. of Economics. The first was published in May, 2010 titled "Impact of= Health Care Reform on Hospital and Preventive Care: Evidence From Massachu= srtts". The second was published in March of this year titled "Mandate-Base= d Health Reform and the Labor Market: Evidence From the Massachusetts Refor= m".

ate-based health reform in Massachusetts resulted in significantly less dis= tortion to the labor market than it would have otherwise. We estimate that = if the government had instead increased insurance coverage by establishing = a wage tax to pay for health insurance, the distortion to the labor market = would have been more than 20 times as large. Our results suggest that manda= te-based reform has the potential to be a very efficient approach for expan= ding health insurance coverage nationally."

Cambridge, MA.

Thank you.

That second paper's conclusion of, "Our results suggest that mandate- based reform has the potential to be a very efficient approach for expanding health insurance coverage nationally." Well, duh!

Personally, I want Health CARE, not Health INSURANCE, I keep envisioning Monty Python's skit about the insurance claim that is NEVER paid, but having insurance gives you peace of mind.

Will check those papers. Thanks again.

One effect of guaranteed issue is that people are gaming the system:

"...which helps explain why small-group coverage in Massachusetts is so much more expensive than in most of the country."

Costs increased:

"Emergency room visits climbed 9%--or 3 million visits--between 2004 and 2008. The bill for uncompensated care has exceeded $400 million."

"Massachusetts taxpayers are not only footing the bill for all this new public spending--they're also facing higher rates for private coverage. A 2010 study published in the Forum for Health Economics & Policy found that health insurance premiums in Massachusetts were increasing at a rate 3.7% slower than the national average prior to the implementation of RomneyCare. Post-overhaul, they're increasing

5.8% faster. Annual premium hikes in the state have averaged 7.5% since 2000.

The average employer-sponsored family health plan costs nearly $14,000. That's higher than anywhere else in the nation."

AIUI the program is popular, but MA was eager to jump on the Obamacare wagon, to cover (ironically) the higher cost.

-- Cheers, James Arthur

Not supported by the data. The actual cost data show a ease in overall cost= increases. This is based on a Blue Cross Blue Shield report published in A= pril, 2011.

Wrong statistic. I show my statistic students how to look for things like t= his. The statistic to monitor is the addmission of patients to the hospital= from the ER. There was a 5.2% decrease in inpatient admissions, which indi= cates more preventive and alternative health care. This results in an overa= ll lower hospital cost since ER addmissions are more expensive.

The second problem with this statistic is that it includes years 2004 to 20=

1. The health care reform didn't go into effect until 2006. The data show = an unusual increase between year 2005 and 2006. This is an outlier for data= after 2006. The data show that there was a relative increas in ER admissio= ns from approximately .01 to .05. After 2006 there was a decrease to about =

-.01, a -.05 relative change. The increase after 2007 was small, and by the= end of 2008 the change was approximately .03 [source: Kolstad and Kowalski= , "The Impact of Health Care Reform on Hospital and Preventive Care: Eviden= ce From Massachusetts", 2011]

Again, data from 2000 to 2006 are not indicative of the effects of a law th= at did not go into effect until after 2006. Very old statistics trick.

MA costs have ALWAYS been higher than the rest of the country. This is base= d on the April, 2011 BCBS report. The increase in cost has decreased after =

2006, when the plan went into effect. The report also shows a decrease from= 22% to 15% for out-of-pocket expenses by families. Employer contributions = have decreased from 82% to 72%.

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st increases. This is based on a Blue Cross Blue Shield report published in= April, 2011.

this. The statistic to monitor is the addmission of patients to the hospit= al from the ER. There was a 5.2% decrease in inpatient admissions, which in= dicates more preventive and alternative health care. This results in an ove= rall lower hospital cost since ER addmissions are more expensive.

2008. The health care reform didn't go into effect until 2006. The data sho= w an unusual increase between year 2005 and 2006. This is an outlier for da= ta after 2006. The data show that there was a relative increas in ER admiss= ions from approximately .01 to .05. After 2006 there was a decrease to abou= t -.01, a -.05 relative change. The increase after 2007 was small, and by t= he end of 2008 the change was approximately .03 [source: Kolstad and Kowals= ki, "The Impact of Health Care Reform on Hospital and Preventive Care: Evid= ence From Massachusetts", 2011]

that did not go into effect until after 2006. Very old statistics trick.

sed on the April, 2011 BCBS report. The increase in cost has decreased afte= r 2006, when the plan went into effect. The report also shows a decrease fr= om 22% to 15% for out-of-pocket expenses by families. Employer contribution= s have decreased from 82% to 72%.

I forgot to add. According to a report by The Massachusetts Taxpayers Foundation, published = April of this year, the annual state spending for uncompensated care droppe= d by $118 million over the first five years of reform. To just state a cost= like this is in my opinion not a good thing. To state there was an increas= e in ER visits, without showing the effects of years 2004 to 2006 (when the= law was not ion effect) is, in my opinion, wrong and misleading.=20

To me, to make a comparison, look at the data before the law and compare it= to the data after the law. Don't mix the statistics to make it look the wa= y you want it to. Don't make correlations without ensuring that there is ca= usality.

[attributions elided]

Nor does it comment on the actual "health" of the population being discussed. Costs *increasing* (but with a resulting healthier population) and costs *decreasing* (with a "sicker" population) can make other comparisons meaningless.

What *other* issues can distort the data in unexpected ways? (I once read that, at that time, the most common, single cause for ER visits in NYC? on Sundays was "sliced hands" :> )

Is, perhaps, a "smart" look (i.e., filtering out extraordinary expenses unrelated to patient care -- like the new yacht for the CEO) at the insurers' annual statements a better 0-th order evaluation (given that you have that data each year)?

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To support this last assertion: I once had to rush my wife to the ER for such a bagel-related injury. But then, passing the time on a business trip, I found the Cadillac of bagel guillotines in a housewares store. My one-time $20 investment has paid off over and over again. If I were Blue Cross, I'd send one to every household.

I doubt that Romneycare makes or breaks the decision to move to Mass. With the demise of Polaroid and the minicomputer companies is Route whatever it was even a high tech mecca any more? I can think of several disincentives to move to the Boston area:

1. Weather
2. The grating local accent. Imagine if your children were to grow up speaking that way. Even the Brooklyn accent was more melodious.
3. Draconian gun control laws
4. Taxachusetts
5. Cutthroat local driving
6. Jampacked transit alternatives

Sorry to hear that. OTOH, I really can't understand how this can be such a common injury. Is there something about *how* they (she?) cut their (her) bagels that predisposes them to this sort of thing? I've cut a fair number of bagels and never came *close* to getting flesh between the knife and its target... :<

(Then again, I haven't had a good bagel in 20+ years so the frequency of bagel cutting has dropped to near nil -- these monstrosities produced around the country are more like dense DONUTS than *bagels*!)

So, what similar issues are local to Massachusetts and affect it's health care system/providers? Immigrant populations? Uninsured? Abnormal per capital (health care) consumption rate? Local customs/behaviors that tend to drive up health risks? (e.g., I think the upper midwest? has the highest proportion of obesity in its population)

Here, we have ER's used as doctor's offices (uninsured?). Not only does that jack up the cost of care but also makes the ER an exceptionally unhealthy place for people who are otherwise *healthy* -- but for trauma, etc. Folks with flu, respiratory infections, etc. -- things that got out of hand that didn't need to.

OTOH, without insurance (and a PCP), its easy to see how these people avoid care out of (financial) necessity. And, probably avoid their ER "bills" (leaving me to pay some portion of them).

[I was reviewing the bill for the *routine* bloodwork I had done for my last physical. Some ~$750 of charges that the insurance company has prenegotiated to ~$90. What does an ER visit look like "undiscounted"??]

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(Assuming a bagel worthy of the term) You're holding a hard round object in one hand, while trying to penetrate the resistant edge with a knife blade held above the restraining hand. There's really only one possible point of support, where the bagel is tangent to a cutting board. Small wonder that the knife occasionally slips and cuts the holding hand. The guillotine supports the lower curved part, and restrains the bagel in the z-axis. Given such as support, the top bladed piece would be unnecessary, if a blade could slide through and then down a slot -- you could spider your hand over the top of the support, with the knife blade always below.

too much of a homework assignment for today.

Ah, OK.

I cut a bagel by setting it *flat* on the table/counter/cutting board. Left hand holds the leftmost half-circle in place, from above.

With a pointed "paring knife" (?), I jab the bagel from the side at a point just to the right of where my left thumb would be WITH THE CUTTING EDGE FACING TO THE RIGHT -- cutting only to the hole in the center (not all the way across the diameter).

Then, rotate the bagel after ~45 degrees of arc has been cut.

Alternatively, use a long "bread knife" while holding the begel in place with the *palm* of the left hand and cutting parallel to the cutting board.

(I use the latter approach when cutting anything that I want to have a fixed, consistent thickness)

OK, so it stands the bagel *up* and literally acts like a guillotine!

Makes sense. As long as it works for you/her!

That is a huge negotiation drop!

Wonder if hospital administrators purposely overcharge indigents for an ER visit knowing they will NEVER pay and therefore the hosptial can simply 'write-off' the cost against the income from paying patients?

Similar item, but never mentioned: banks issued credit cards to unsound clients, enticing them into using the cards. When they could not longer pay, the banks slapped on excessive late fees, penalty fees, etc etc until the poor person either attempted to pay up in good faith, or simply defaulted and walked away. THEN the bank simply wrote off the amount owed and used that as a tax hedge against profits made elsewhere, thus, issuing credit cards to bad risks actually made them more money.

Yeah, I was convinced I was looking at some *other* bill... "What the heck did I spend $700 on?"

The Cynic in me immediately thought that. OTOH, I wonder if their "not-for-profit" status makes that sort of thing a moot point?

OTOH, they could use it to "claim" they have provided (forgiven) $X of "care" for the community at no cost (to justify their non-profit status)

The lesson to be learned is that "insurance" gives you a big win even if it doesn't reimburse you for these expenses (because it caps what the provider can charge).

Sheesh!

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st increases. This is based on a Blue Cross Blue Shield report published in= April, 2011.

A common claim is that universal care will reduce ER loads. Further, the story goes, that's costing us money. So, it's a perfectly reasonable statistic to look at.

That was but a snip from a broader, more comprehensive article. More points are raised there.

tic to monitor is the addmission of patients to the hospital from the ER. T= here was a 5.2% decrease in inpatient admissions, which indicates more prev= entive and alternative health care.

No, you're assuming that.

ore expensive.

Assumes facts not in evidence. If, for example, ERs get lots of uncompensated visits, that might be their major cost, not admissions.

Also, the report you're citing relates to HOSPITAL costs.

2008. The health care reform didn't go into effect until 2006.

That's potentially a valid point--the assumption is that ER visits are fairly steady, that emergencies don't spike much over time. An increase of 9% in ER visits in 4 years is a lot more than expected based on population growth. An unusual event might affect that. Hard to see what, though.

Here's another statement from the Forbes article: "RomneyCare expanded coverage simply by putting more people on the dole. Since 2006, 440,000 people have been added to state-funded insurance rolls. Medicaid enrollment alone is up nearly 25%, and Massachusetts is struggling to cover the cost."

That's a pretty clear statement. Boosting Medicaid enrollment up 25% is, well, simply putting more people on the dole.

that did not go into effect until after 2006. Very old statistics trick.

The comparison is 3.7% below nat'l rate before, and 5.8% faster after. What / how can you compare "after" to without looking "before?"

sed on the April, 2011 BCBS report. The increase in cost has decreased afte= r 2006, when the plan went into effect. The report also shows a decrease fr= om 22% to 15% for out-of-pocket expenses by families. Employer contribution= s have decreased from 82% to 72%.

Quoting from that report:

39821f74c723c7.pdf "The cost of health care and the annual rate of increase in health care spending remains a challenge. With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020."

Double in 9 years? That's 8% a year. That's a disaster. Not only have costs jumped, making it less affordable, but the rate of growth has been increased on top of that.

Anything that increases faster than real wage growth is unsustainable. Increasing the rate of cost growth is unhelpful.

-- Cheers, James Arthur

What make you think hospitals are "not-for-profit" ??

There is a lot of truth to that, but prove it.

(In the US,) about 80% of all hospitals are "not for profit". [I include hospitals owned/operated by governmental agencies] This usually gives the hospital some preferential tax treatment in various tax jurisdictions (real estate, "profit", sales tax exemptions on purchases, etc.)

[I have no idea if there are also "breaks" for the "for profit" organizations or if that is on a case by case basis]

Part of the "deal" with non-profits (in general, not just hospitals) is that they have to provide "services to their community". For a hospital, this can be things like "awareness" programs, health screenings, safety training, etc.

And, no doubt, some amount of "uncompensated care". This last item being easiest to put a firm dollar figure on -- "We billed the patient $X and forgave $Y (Y

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Gees, you hold the bagel (*gack*) from the top, with your hand over the back of the blade. The knife cuts down, AWAY* from the hand. I suppose you cut by drawing the blade towards you, too.

titled "Mandate-Based Health Reform and the Labor Market: Evidence From the Massachusetts Reform".

**-----------------------^^^ A tree dies for THIS??

mandate-based health reform in Massachusetts resulted in significantly less distortion to the labor market than it would have otherwise. We estimate that if the government had instead increased insurance coverage by establishing a wage tax to pay for health insurance, the distortion to the labor market would have been more than 20 times as large. Our results suggest that mandate-based reform has the potential to be a very efficient approach for expanding health insurance coverage nationally."

Cambridge, MA.