As a physician, I feel I have a few insights to share about Mitt Romney’s “Universal Health Care Plan” signed into Massachusetts law on April 12th, 2006 (which some have dubbed: “RomneyCare”). By way of background see the following links:
Those “in the know” see the potential of Romney . . . this is the second round that he’s held the #2 spot at The National Journal.
The Heritage Foundation’s take is quite supportive (granted, they have a vested interest)
Here is a link that links to several other op-ed pieces and are generally favorable (if not celebratory)
If you’ve got time . . . you can watch Mitt himself giving a 25 minute speech/PowerPoint with a 15 min Q&A session following about his plan (given at The HeritageFoundation)
First off, I preface my remarks by stating that the United States medical care is the best in the world. This is largely because of our free-market system in both clinical care and biomedical research. People are living longer and healthier lives because of innovation, dedication, and the “desire for wealth” which spurs individual and corporate enterprises. I am proud to be part of this system which is unparalleled worldwide.
Romney’s plan does not represent “socialized medicine” or even a step down the slippery slope that could lead there . . . no, this is not the road to HillaryCare. Every physician I know cringes at the idea of socialized medicine (for the negative effect it would have on us and our patients—a true “lose-lose”). On the flip side, every physician I’ve spoken to lately seems very supportive and intrigued by Romney’s plan. This is significant, and should allay any fears of this being a stepping stone toward socialized medicine.
The plan is not even a “government takeover” of medicine as some are claiming. There are no new “government insurance plans” to sign up for. The government’s involvement is mainly in oversight to ensure that everyone is insured (just like the good old car insurance analogy . . . by the way, is anyone complaining of a “government take over” of the car insurance industry?)
Romney recently rebuffed such claims of “big government” by responding that "making the individual responsible for his own health coverage is a lot more conservative than a permanent program of government handouts to hospitals." Edmund F. Haislmaier stated that “those who want to create a consumer-based health system and deregulate health insurance should view Romney's plan as one of the most promising strategies out there.”
Although libertarians may cringe at the government "mandate” that this law institutes what they must realize is that this simply supplants previous mandates. This law appropriately shifts the burden of the uninsured away from the Emergency rooms and hospitals (who under COBRA and EMTALA federal laws, ARE CURRENTLY MANDATED to treat all comers for emergency services regardless of their insurance—or lack thereof) to the individuals . . . exactly where it should be (hey, most people don’t flinch one bit about plopping down several hundred dollars to have their teeth worked or to get glasses/contacts . . . so why does almost everyone seem convinced that medical care should not have any out-of-pocket expenses?)
Another great aspect of this plan is that it requires even the poor to pay at least something for their healthcare (excluding Medicaid recipients). Romney keeps saying that this plan will eliminate the “free lunch” mentality toward healthcare that most low-incomers have. This will also build self-worth and individual accountability as the self-defeating hand-out system will diminish greatly. The private insurance premiums will be subsidized by the government on a sliding-scale for lower-income individuals and the very poorest will still be captured and covered, at least in part, by federal Medicaid funding.
A fascinating component of the Mass. plan is “The Connector” which came about through Romney’s reaching out to the conservative think tank “The Heritage Foundation.” This entity will allow the self-employed or part-time workers to obtain the benefit of pre-tax dollar utilization for insurance premiums (a benefit currently reserved for those whose health care coverage is provided by their employers.) In effect, this amounts to a tax-cut/tax-break (true to Republican principles . . . even in the Bluest of Blue states . . . how did Gov. Romney get this done?). In addition, “The Connector” will allow portability of insurance plans as individuals change their employment as well as allowing folks with multiple jobs to pay pre-tax off of multiple paychecks. Slick and practical stuff.
“Where is the accountability built into this system?” you may ask. Those who do not obtain insurance will lose out on their state personal tax exemption (among other penalties for individuals and businesses). This straightforward enforcement/incentive program will yield results quickly. People will also be blocked from obtaining/renewing driver’s licenses if they cannot provide proof of healthcare insurance.
Some have criticized Governor Romney’s veto of the $295/employee fee (per annum) for employers who do not offer insurance for full-time employees. Everyone knew that his veto would be overturned by the legislature and this play of events ended up being a “win-win” for Romney. He can claim to be business friendly and for smaller government (which he honestly is)—while inclusion of the fee gives the plan itself an even better chance of being fiscally successful. If this plan is successful it will bode very well for Romney in 2008.
Will it work? I predict that since people will have insurance they will seek outpatient primary (preventative) care early in their disease course instead of stumbling into emergency rooms on death’s door. If this helps keep people out of emergency rooms and hospitals where costs are massive then this will work AND improve the general public health.
The bigger money-saver, however, will be in getting non-emergent patients out of emergency rooms for their primary care. Uninsured and poor people know that, by law (COBRA & EMTALA) emergency rooms have to see and evaluate them for ANY complaint they may have. My brother is an ER physician and is constantly amazed how the ER system is abused by so many patients . . . like coming in at 3 AM because they’ve had “the sniffles” for a week.
Governor Romney’s response when asked by Chris Matthews on MSNBC’s Hardball if such a plan could work for the nation highlights many of these points:
“Well, it will work for Massachusetts, and that’s of course the thing that I had to focus on. There are certain aspects of it that I think would work across the country, perhaps better in some states than others. Of course the great thing about federalism is you let a state try it and see how it works before you spread it out.
“But there’s some key features and I think this is one of them, which is that we are already spending billions of dollars in our country and in my state, about a billion dollars, giving free care to people who don’t have insurance. And the question was, if we took that money and helped them buy insurance, could we have everybody insured and the answer is yes.
“We don’t need new money. We don’t need new taxes. We could use the money we’re currently spending and get people better health care without having the burden and the cost of the uninsured being borne by everybody else.”
By the end of this interview Chris Matthews exclaimed: “God, it sounds wonderful. I’m not supposed to cheer here, but I mean, I think it’s wonderful.” This is what happens when you mix a good plan with the right man. I’m pretty sure that this is the right plan . . . but everything I’ve seen so far tells me that Romney is definitely the right man.