Posts Tagged ‘RomneyCare’
BETSY MCCAUGHEY: Presidential aspirant Mitt Romney may not have intended that the mandatory health insurance law he signed in 2006 would look like the Obama health law. But the Massachusetts law does a lot more than cover the uninsured (a worthy goal). The law broadens the powers of government to dictate treatment decisions and even interferes in where and how patients die. The result will be a breathtaking shift of decision-making from the doctor at bedside to the state.
The Massachusetts law has come under fire for soaring premiums, now the highest in the nation. A 2011 Beacon Hill Institute study concluded that 18,000 fewer people were employed in the state, because employers required to provide coverage left the state or stopped hiring to avoid the cost. But the cost cutting has begun, and the results are alarming.
Chapter 305 of the 2006 law created councils and regulatory bodies charged with cost-cutting, and after several years they have produced a plan. Here are key components:
Mandatory electronic medical records: All physicians must comply by January 2015 as a condition of keeping their medical license.
Comparative effectiveness: A state board — with unions, consumers, employers and other nonphysicians on it — will synthesize medical research into guidelines and ensure that all insurers and doctors follow them. These guidelines will lay out what care is “medically necessary” and include “how to address individual patient cases and circumstances.” Massachusetts says it and its bureaucrats can make better decisions than highly trained physicians at bedside. (Roadmap to Cost Containment pp. 10, 21,36)
Massachusetts’ End of Life Program: Sec. 41 of Chapter 305 of the Massachusetts law creates an expert panel to deal with how and where people die. The state will launch an aggressive public relations campaign to get hospitals and doctors to encourage palliative care, hospice care, and death at home. In Massachusetts, only 24 percent of people die at home. The state says that is too low. (Roadmap, pp.32,33, 41,90,)
Sometimes a patient doesn’t die at home because the doctor doesn’t foresee that death is imminent. A 2006 Emory University study found that doctors treat patients who are expected to die less intensively than patients who are expected to survive, but often doctors can’t predict who is near the end.
The benefits of hospice care are obvious. But physicians also worry that some patients will break down at the mention of hospice care and lose the will to fight their disease. Ultimately, the question is how involved should government be in how we die, especiall when the goal is to cut costs?.
Ending fee-for-service insurance options: Massachusetts will push patients into “medical homes,” to limit access to costly specialists and diagnostic tests, and substitute nurse practitioners and physicians assistants for doctors.
A 2008 Congressional Budget Office report noted that. if cost control is the priority, medical homes are likely to present the same problems as those HMOs of 20 years ago.
HMOs would withhold physicians’ fees until the end of the year and give it back only to the physicians who met targets for limiting referrals or diagnostic tests. Ultimately, what a doctor prescribed for a patient came out of the doctor’s own pocket at the end of the year, setting up a conflict between you and your doctor. (Roadmap, p. 14)
RINO-WATCH: Is this really who we want leading the conservative charge in America?
BOSTON GLOBE: When the Massachusetts Legislature made health insurance mandatory five years ago, supporters of the first-in-the-nation law hoped it would keep patients out of hospital emergency rooms.
Patients with insurance, the theory went, would have better access to internists, family practitioners, and pediatricians, lessening their reliance on emergency rooms for routine care.
There is more evidence today that it did not turn out that way.
Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.
They cited ”physician shortages” along with a growing elderly population as the top two reasons why more patients come to ERs.
The law ”didn’t create an infrastructure,” said Dr. David John, chief of emergency care at Caritas Carney Hospital in Boston. “Doctors offices are full to capacity.”
The number of doctors who responded to the survey by the American College of Emergency Physicians — 56 from this state — is small. But their responses echo findings from last July, when state health officials found that ER visits rose 9 percent from 2004 to 2008, to about 3 million visits a year.
But what about RomneyCare?
BOSTON PHOENIX: When Mitt Romney’s second book, No Apology, came out a year ago, it looked like he was moving away from the far-right demagoguery of his 2008 bid for the presidency, and toward a more moderate centrism for the 2012 election cycle. (See “New and Improved Romney,” Talking Politics, February 10, 2010.)
But does Mitt. A year later, with the Tea Party–fueled extremism of the 2010 midterms foretelling a rightward tilt to the GOP presidential primaries, Romney is tacking back — as evidenced by changes made to two sections of the text in the new paperback edition of No Apology.
The first rewrite excises a relatively even-handed assessment of the 2009 economic-stimulus package. In the original, Romney wrote that it “will accelerate the timing of the start of the recovery, but not as much as it could have.” The paperback pronounces the stimulus “a failure,” and blasts Obama’s “economic missteps” with conservative red-meat language — for example: “This is the first time government has declared war on free enterprise.”