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Fort Worth Star-Telegram, Texas, Steve Jacob Column

Posted on: Friday, 28 April 2006, 12:01 CDT

By Steve Jacob, Fort Worth Star-Telegram, Texas

Apr. 28--In 1988, Gov. Michael Dukakis claimed the Democratic presidential nomination by also claiming credit for the "Massachusetts Miracle."

High-tech and financial service industries blossomed in the Boston area during the 1980s after the state had been decimated by a massive exodus of manufacturing. Unfortunately for Dukakis, the state's economy faltered during his presidential campaign, helping put George H.W. Bush into the White House.

Two decades later, another Massachusetts governor apparently hopes to ride another miracle to a presidential nomination. Gov. Mitt Romney, barely concealing his desire to be the Republican standard bearer in 2008, recently pulled off a remarkable political feat: orchestrating bipartisan support for enacting compulsory health coverage for all Bay State residents.

Romney equates the measure to mandatory auto insurance. Businesses that don't offer health insurance pay penalties that are earmarked to help cover the uninsured. The state is using a relatively modest increase in state spending, tax incentives, subsidies and government insurance programs to cover what lawmakers hope will be 90 percent to 95 percent of its current 550,000 uninsured residents by 2009.

Before this breakthrough, universal health coverage seemed a political impossibility. Liberals' solutions inevitably pointed toward large government spending increases. Conservatives demanded private-sector approaches. The Massachusetts approach adroitly distributes the cost among individuals, business and government. It insists on personal responsibility while offering a helping hand to those who qualify.

Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington, told The New York Times: "This is probably about as close as you can get to universal [coverage]. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

But for some, universal coverage does not go far enough. They advocate government-funded health coverage for everyone. This is particularly favored by healthcare providers weary of dealing with the middlemen that get between them and the patient, including managed care organizations, insurance companies, and billing and collection agencies. They argue that the efficiency of a card-swipe payment system and government-negotiated fee-for-service rates ultimately would be no more expensive than what we have now.

With or without the government, the nation's haves subsidize the healthcare of the have-nots. They do so with a combination of taxes, higher insurance payments and higher medical bills.

Healthcare providers absorbed about $35 billion in uncompensated care in 2003. But those costs are shifted to taxpayers who subsidize public hospitals, higher charges for those who pay their bills, and higher insurance premiums for businesses and their employees. Texas family health insurance premiums were $1,551 higher in 2005 because of uncompensated medical care, according to a 2005 Families USA study.

Most of the uninsured in Massachusetts fell into three groups, the proportions of which are fairly typical nationwide:

About 20 percent were poor people who qualify for Medicaid but haven't bothered to sign up. This represents new spending for the state, but this group is entitled to a program.

About 40 percent are low-income households that don't qualify for Medicaid but cannot afford health insurance. The state will subsidize their premiums.

The remaining 40 percent were the primary target of the mandate. They can afford health insurance but simply choose not to buy it. When they are hit by catastrophic medical bills, they can't pay, so the rest of us have to pick up the tab.

Several insurance-market reforms will make health insurance cheaper and easier to buy. Beginning in 2008, Massachusetts residents without insurance will be fined equal to half the cost of annual premiums.

Only 7 percent of Massachusetts' residents are uninsured. By far the nation's leader, Texas clocks in at about 27 percent uninsured. In raw numbers, Texas has nearly 10 times more uninsured residents.

John Hawkins, vice president of government relations for the Texas Hospital Association, says that Texas could duplicate the Bay State's feat with enough political will. Hawkins points out that nearly a third of the state budget is consumed by Medicaid and healthcare costs for teachers and state employees.

To publicize the national Cover the Uninsured Week, which begins Monday, THA released a poll Thursday showing that 86 percent of Texas voters favor making health insurance more accessible and affordable.

"It would be more difficult mechanically" to achieve universal coverage in Texas because of the state's size and more complex funding sources, but "conceptually, it could be done with some tweaking," Hawkins said.

Candidate Romney probably will be pushing a national solution for universal coverage, but he's likely to face the same political forces that helped derail Bill Clinton's healthcare initiative of the early 1990s. Expect this to be addressed -- and potentially solved -- in state capitals rather than in Washington.

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Copyright (c) 2006, Fort Worth Star-Telegram, Texas

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NYT,

Source: Fort Worth Star-Telegram (Fort Worth, Texas)

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