Still fixing the fixed, fixed healthcare system

by Daniel Becker

I posted in 7/2009 on the issue of fixing our healthcare system based on the Massachusetts model. The first was Massachusetts is fixing the fixed healthcare system.   The second was a followup to the first:  Fixing the fixing. Healthcare Deja vu.

The issue was that we are dancing around. All the proposals to date have been nothing more than a relabeling of already tried organizational structuring within the private insurance model.  I ended the first article with a quote from a NEJM report and a my question:

Despite these imprecisions, the difference in the costs of health care administration between the United States and Canada is clearly large and growing. Is $294.3 billion annually for U.S. health care administration money well spent?

Well, is it? Did they even ask?

I ended the second article with:

We’re talking the same old approach to what really is a problem with the product. At least in the bad socialist health care programs they recognize that a for profit third party only adds cost and thus do not have to account for that part of our problem (it’s called savings). They just need to resolve the product quality issue. It is the only common issue to all nations.

I’m taking bets on the date of the new fix of the newly fixed, fixed system.

Ok folks. The betting is closed. Time to lay the cards on the table.

US News and World Report: Mass. Health Reform Hasn’t Halted Medical Bankruptcies

“Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance. High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs. None of that changed. For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” the researchers wrote.

The results from the actual published article in The American Journal of Medicine:

In 2009, illness or medical bills contributed to 52.9% of bankruptcies in Massachusetts. In contrast, in early 2007, medical bankruptcies accounted for 59.3% of personal bankruptcies in the state (P#.44 for comparison with 2009 proportion) and 62.1% nationally (P#.02). Because the total number of personal bankruptcy filings in Massachusetts increased by 51% between fiscal years 2007 and 2009(6) the absolute number of medical bankruptcies in the state actually increased by more than one third during that period, from 7504 to 10,093.

The profile of the bankruptcies:

Most of the recent Massachusetts debtors were female (Table 1). Their average age was 48.2 years, two thirds of them had attended college, and 70.5% owned a home or had owned one within the past 5 years. The average debtor household included 2.94 persons; in three quarters of them, at least 1 adult was employed at the time of bankruptcy filing.

In 2009, 45.6% of the entire sample (86.2% of the medically bankrupt) had high medical bills or specifically cited illness as a cause of their bankruptcy, proportions that did not vary by insurance

status. The remaining 13.8% of the medically bankrupt (7.3% of the entire sample) were classified as medically bankrupt because they had lost significant work-related income because of illness or had mortgaged a home to pay medical bills.

As would be expected in a state where medical insurance is mandatory, the overwhelming majority (89.0%) of debtors had health insurance for themselves and all of their dependents at the time of bankruptcy filing…

The 2009 coverage rates in Massachusetts were higher than those for Massachusetts debtors in 2007 (before the coverage mandate was enforced), when 84.1% had insurance at the time of filing and approximately one third (34.1%) had experienced a coverage gap. In both 2007 and 2009, Massachusetts debtors’ had higher coverage rates than in our 2007 national sample, in which only 69.7% of bankrupt families were insured at the time of filing and 37.4% had experienced a gap.

Here we go folks, the table is open. Taking new bets.