This case is only in the 7th ed. Steph, assuming you have the 7th ed. , would you summarize or repost the case for everyone using the 6th ed.?
Also, remember to distinguish ethical from medical/social/legal/other issues, and present any other information necessary to understanding the case (you might want to do a tiny bit of research if there's some particular angle that seems interesting to you). You are also responsible for constructing relevant (thought-provoking) questions to start discussion on the case issues.
Others: respond to Steph's awesome questions/discussion prompts.
For right now I have just typed up the case in its entirety so anyone with the 6th edition can see it. I need to do some research before I analyze the question and add more to it.
ReplyDeleteCase 42
In April 2006, under the leadership of Governor Mitt Romney, Massachusetts passed significant health-care legislation. The new law had several key elements. First, eligibility for Medicaid was somewhat expanded. Second, it required individuals with income levels above the poverty line to purchase a private insurance policy for themselves or their families, with the state offering partial subsidies to families within 300 percent of the poverty line. Third, a new state agency called “the Connector” was designed to connect people with private health insurance plans and to help design affordable plans. In addition, citizens were permitted to use pre-tax dollars to buy health insurance, and businesses employing more than ten people were required to pay a small fee if they declined to provide health insurance to their employees.
The results of this Massachusetts legislation (as of 2009) have both favorable and unfavorable aspects. The percentage of uninsured personas fell from 6.4 percent in 2006 to 2.6 percent in 2008, a sizeable improvement in coverage. At the same time, the state is struggling to control rapidly rising health-care costs and the legislature voted to cut back on benefits for thousands of legal immigrants. Moreover, Boston Medical Center has sued the state on the grounds that the new law has driven the hospital into deficit. According to critics, Massachusetts-style health-care reform is doomed to failure because, rather than addressing the structural inefficiencies of the American health care status quo, it essentially just requires people to buy health insurance without enabling (through adequate subsidies) enough of the poor to do so. In a word, neither universal coverage nor cost controls is possible with this approach. On the other hand, a strong majority of Massachusetts residents express support for the reform in polls. Some even take the state experiment as a model for health-care reform on a national level. MIT economics professor Jonathan Gruber expressed this opinion: “I think the Massachusetts model is an excellent one for what it tried to accomplish: moving to universal coverage by building on the existing insurance infrastructure.”
(1) Is health-care reform along the line of the Massachusetts approach—featuring an individual mandate” to purchase insurance—likely to achieve universal coverage, cost control, and other important health-care goals? (2) Would health-care reform that more drastically restructured the health insurance market or massively expanded public insurance be more likely to achieve major health-care goals? (3) Which sort of reform is preferable, all things considered: Massachusetts-style reform or more fundamental reform? What role should considerations of political feasibility play in this discussion?
The majority of issues in the question of universal health care stem from political philosophy and the legality of a mandate. Some questions to consider in addition the ones posed in the text book might be:
ReplyDeleteWhat is wrong with our current health care system that everyone seems so desperate to fix?
Is there a right to health care?
A portion of health care cost is the result of people who choose not to get regular checkups and then have a preventable, disabling event occur. Even with insurance to promote preventative care, would people actually go to the doctor on a regular basis?
Is the mandate to purchase health insurance constitutional? Is it any different than if the government required everyone to purchase a vehicle?
If you think we need health care reform, what type of reform do you think would be best and why?
•The AMA proposal given on pg 675-680 of the textbook increases competition among insurance companies by allowing more options for individuals, provides a tax credit as incentive to purchase insurance rather than installing a mandate, and enhances the market with guaranteed renewability and premiums based only on age and sex.
•Current reform methods mandating everyone purchase an insurance policy
•Expansion of public care to be a single payer system
I think that the government needs to take more drastic measures in order to really improve healthcare. The Massachusetts system is a poor fix for a critically flawed system. I noticed that while the hospitals and government were hurt by the bill, no talk is made about the health insurance agencies. I believe a better bill would have prevented insurance companies from making profits.
ReplyDeleteAt the same time, the government should not mandate people to buy health insurance, but should simply provide it (if anything). This way, people can then decide whether or not they want to actually use it. As far as people that don’t go to the doctor enough for regular check-ups, I think providing insurance would encourage them to do so more often. Without insurance, they likely avoid healthcare until it is too late, in an attempt to initially save money (though it obviously costs more in the long run). We simply need to keep people informed about how their lifestyle affects their health. We need to change from a country that values excess to a government that values health.
The AMA proposal would do a good job of increasing insurance company competition and encourage more people to buy health insurance, eliminating the need to install a mandate, as well as cutting down on health insurance agency profits. Even so, this proposal does not call for universal coverage, which is a fundamental and necessary change that needs incorporated into our future healthcare system.
There is lots of talk about lack of finances to instigate change, but when I see how much money we waste subsidizing big corporations or feeding government salaries, I believe a little rearranging of our priorities would provide the money in excess.
I don't think the Massachusetts reform is completely effective because it was not successful in getting everyone to buy insurance. The rate of uninsured did go down but there was still 2.6% of the people without insurance. Who would be in charge of making sure everyone had insurance and what would be the penalty if they did not buy it? The plan did not include regulation of the cost. Until somone starts regulating the insurance companies, prices will continue to rise because the companies are for-profit. If the people are forced to buy the insurance no matter what, the prices may continue to increase and the people will still have to pay. Lastly, even though people have insurance, it does not mean they will make healthier life-style choices or even get regular check-ups. Preventative medicine will be available to them but who says they will use it? I agree that preventative medicine is cheaper in the long-run but not if people are continuing to wait until they are ill to go to the doctor.
ReplyDeleteI believe that reconstructing the health-care system would be the best choice to achieve major health-care goals. I think the AMA has some good starting ideas to change the system. There proposal allows for more choices to receive insurance. A person can get insured through their employer or purchase it independently. The tax credits would be an incentive for some to become and maintan being insured. The poor would get more tax credits back and therefore be more affordable for them. More choice in the market should also decrease the cost because more companies would be competing to attrack more people to their company.
I think fundamental reform is more preferable. This is because people will have more choice in the matter and it will also cut down on the cost. In the Massachusetts reform, people are being forced into paying for something they might not neccessarily want and there was no control over the cost. Political feasibility needs to play a role in this discussion otherwise the proposal will never be put into law.
A side note--the 2.6% remaining uninsured had a religious exemption
ReplyDeleteThe Commonwealth Connector can help you learn more about the health care reform law. The Connector administers two programs: Commonwealth Care and Commonwealth Choice. Commonwealth Care connects uninsured individuals with incomes that fall within certain guidelines, and who meet other qualifications with approved health plans, and helps them pay for them. Commonwealth Choice offers private health insurance options for individuals, families and employers.Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level, and low-cost insurance for all other residents who are not eligible for insurance through their employers.
ReplyDeleteRight now, healthcare reform is the subject of a fierce partisan debate in Washington DC. There is a reason for this; the US healthcare system is really messed up and it needs fixing. Issues involve high costs, high rates of disease, poor quality of care, unaffordable treatment, and poor statistics when comparing our system to other countries’ systems. America spends far more money per capita on health care than other countries. A majority of Americans complain that their doctors neither spend enough time with them nor respect them. Many US adults have problems paying medical bills and are hounded by collection agencies.
ReplyDeleteAlthough the idea of everyone having healthcare is a wonderful idea, it is something that no one has a solution for right now. For whatever reason people don't have healthcare, some people don't have it because they simply don't want it: they don't think they need it, they don't think the government should tell them what to do, they don't trust doctors, or they have religious issues with healthcare. I think a legislation like the one above is going to have to target this group of people. Eventually, the people who have to pay for it will do so, but those who don't "believe" in the healthcare system will still be hesitant. The government could force people buy the healthcare, but where is the money coming from for the increased need of jobs vouchers for the poor and other various costs? I do think that something needs to be done, but I don't know if America should be forced into getting healthcare. With that being said, if something is going to change, there is going to have to be a period of time when a lot of people are unhappy with the changes, even more than they already are.
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