Friday, March 19, 2010

Scaling Up Health Care Reform

I was employed as a research chemist at a large pharmaceutical company for 34 years, with the last 26 as a process chemist. Chemical compounds that have been previously synthesized on a small scale, anywhere from a few milligrams (thousandths of grams) to five grams or so, are prepared in larger, sometimes much larger, amounts - up to multi kilograms (thousands of grams) by process chemists. Very often, a process workable on a small scale is not feasible on a large scale. Modifications are always necessary and sometimes the entire process needs revamping. Never is an attempt made to synthesize a large quantity of a compound without first running trial reactions, making a few grams and then gradually scaling up. Not following an incremental approach is courting disaster. At best, a highly inefficient, wasteful and needlessly expensive process results. At worst, the entire project blows up. Literally.

Obamacare is the health care equivalent of synthesizing many kilograms of a compound without any prior process development. And it's being rushed into law while while its proponents are ignoring an ongoing experiment that is producing some useful, relevant data. The state of Massachusetts is presently trying out a mini-me version of Obamacare. After only three years of operation, that system, call it RomneyPatrickcare, is already facing serious problems. These were outlined in a WSJ op-ed (3/17) by Grace-Marie Turner.

While Massachusetts' uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers.

More than half of the 408,000 newly insured residents pay nothing.

Another 140,000 remained uninsured in 2008 and were either assessed a penalty or exempted from the individual mandate because the state deemed they couldn't afford the premiums.

A typical family of four today (in Massachusetts) faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.

Further, insurance companies are required to sell "just-in-time" policies even if people wait until they are sick to buy coverage. That's just like the Obama plan. There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.

Some Massachusetts safety-net hospitals that treat a disproportionate number of lower-income and uninsured patients are threatening bankruptcy. They still are treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut under the reform deal.

The Bay State is also suffering from what the Massachusetts Medical Society calls a "critical shortage" of primary-care physicians. As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn't been a corresponding increase in the number of doctors. As a result, many patients are insured in name only: They have health coverage but can't find a doctor.

Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients, according to a 2009 physician work-force study conducted by the Massachusetts Medical Society. For new patients who do get an appointment with a primary-care doctor, the average waiting time is 44 days, the Medical Society found.

As Dr. Sandra Schneider, the vice president of the American College of Emergency Physicians, told the Boston Globe last April, "Just because you have insurance doesn't mean there's a [primary care] physician who can see you."

The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn't actually require immediate treatment and could have been dealt with at a doctor's office—if patients could have found one.

Faced with soaring medical expenses, Gov. Deval Patrick, Mr. Romney's successor, wants to cap insurance rate increases at 4.8%, not the 8% to 32% increases the companies have requested for April 1. Three of the four major health insurers in Massachusetts showed operating losses for 2009. If their rates are capped, they say they'll be forced to cut payments to health providers, putting further pressure on doctors and fragile hospitals.

Someone who should know, Massachusetts State Treasurer Tim Cahill, had this to say about his state's system and the Democrats' proposed plan.

If President Obama and the Democrats repeat the mistakes of the health insurance mandate in Massachusetts on a national level, they will bankrupt this country within four years. It is time for the President and the Democratic Leadership to go back to the drawing board and come up with a new plan that does not threaten to wipe out the American economy.

Make no mistake – I firmly believe in the right of every American to access good quality health care. But as Congress and President Obama prepare to ram through a government run health care plan, they should heed the warnings about the way in which Gov. Patrick has managed the same model in Massachusetts.

No process chemist would ever consider proceeding with a super sized reaction before obtaining definitive results from smaller trial runs, especially when one of the trials is showing ominous signs of going awry. Yet this is what the Democrats are doing as they force their massive social experiment on an unwilling American public. An item the other day on Yahoo News (big Obama fans) claimed that whatever one thinks of the proposal, there's no doubt that it's "bold". No. The word is reckless. Irresponsibly. Dangerously. Reckless.

Warning! - Everyone stand back!

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