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Respecting the rights of all means that I respect your right not to eat meat or to eat meat from a supermarket and not to hunt. I expect the same respect.
Democrats' health bills depend on forcing individuals to buy insurance or face severe fines or imprisonment.
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Andrew Cline has been editorial page editor of the New Hampshire Union Leader since October of 2001. His writing has appeared in more than 100 newspapers and magazines, including The Wall Street Journal, The Washington Post, and National Review.Why Obama spoke in NH and not next door
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Reader commentsApparently people in Washington think we pay no attention to what happens in our neighboring states. The President decided to speak on government health care plans in New Hampshire because each of the neighboring states has had a failed experiment with exactly the kind of changes Washington wants to bring to all of us.
None of the rhetoric in the President's speech was new to New Englanders. All of it is eerily reminiscent of the hopes and dreams of Dirigo Choice in Maine and Commonwealth Care in Massachusetts. Both of those plans went into effect, and neither has proved effective, which makes it odd that Congress and the President wish to develop a plan by copying the broad outlines of the "Massachusetts model."
Dirigo Choice was our region's first foray into having the government save money by spending money. The law was passed six years ago, about a month after it was introduced. Despite the short period of study, supporters were confident Maine's bold new experiment would prove a model of reform for states around the country. Maine's state slogan, "Dirigo," means "I lead." They hoped that as Maine went, so would go the country.
Dirigo's promise was great. It would eliminate the uninsured with no taxes at all. The plan would be paid for by savings in uncompensated care and end up reducing insurance costs for everyone. The plan included a significant Medicaid expansion and a subsidized government or "public option."
Six years later, it turns out that what sounded too good to be true was too good to be true.
Dirigo hoped to sign up 30,000 uninsured residents in year one and all 140,000 estimated uninsured residents by 2009. How did it do? In 2009, the Dirigo plan -- which promised to lead the nation and serve as a model for all -- covered about 3,500 previously uninsured people, or about 3 percent of its goal.
As for having no cost, the Dirigo plan has cost Maine taxpayers $150 million. Despite the taxpayer subsidy, premiums have been increasing and benefits dropping. Dirigo premiums climbed 74 percent during a period when state employee premium costs climbed only 17 percent. Skyrocketing costs have also required significant benefit reductions in the public plan. Hospital costs, for example, are now reimbursed at 70 percent, not 80 percent.
No wonder long-time Dirigo chronicler Tarren Bragdon called his look back at Dirigo "A Series of Unfortunate Events."
Just as unfortunate was the recent Massachusetts effort that is serving as a template for most of what Congress and the President want to do. Massachusetts added individual and employer mandates -- every business with at least 10 employees had to offer insurance to employees, and every resident of the state not otherwise covered had to buy insurance. There were subsidies for families earning as much as $66,000.
Lawmakers assumed that if everyone had insurance, premiums would decline on average. More important, they assumed that emergency room usage would decline significantly and the state would save millions on uncompensated care. Then-governor Mitt Romney predicted premium decreases of 25 percent or more.
But politics will always intervene. Rather than offering middle income people and young professionals a simple catastrophic plan, more and more mandates were added. As a result, premiums have increased, costs are out of control, and many are still uninsured despite a mandate to be insured.
Rather than declining, insurance premiums in Massachusetts are rising much faster than the national average. The cost of family coverage is about 30 percent higher in Massachusetts than the national average. In addition, the waiting time to see a doctor has increased from 33 days to 52 days.
Commonwealth Care, the subsidized insurance part of reform, will cost almost $900 million, about 20 percent higher than projected. To make up for the shortfall, the state ordered subsidized insurers to cut payments to service providers and is considering capping insurance premiums, excluding some residents from eligibility, and limiting coverage to "services that produce the highest value when considering both clinical effectiveness and cost." In other words, rationing.
Despite the costs and the subsidies, 3 to 6 percent of the population -- depending on the measurement used -- are still uninsured. Rather than creating an affordable option, state mandates made unaffordable premiums less affordable.
Dirigo Choice and Commonwealth Care were both noble experiments that adopted one approach to try and expand care and control costs. However, they failed. If states really are laboratories of democracy, as we often say, we should look carefully at the results of these experiments. They failed. It would be a shame to recreate them on a national scale.
Charles M. Arlinghaus is president of the Josiah Bartlett Center for Public Policy, a free-market think tank in Concord.
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YOUR COMMENTS
Don from Milton,
I am a registered independent and obtained entrance to the obama pep rally only because my fiance posed as an obama supporter. I asked the last question of pep rally, why there is one healthcare system for congress and one for the rest of us. The question was not answered at the rally, nor has it been since. In fact the white house announced that future "townhall" meetings will now feature pre-screened questions.
Obama spoke in Portsmouth, because he could count on the support of other like minded tax and spend politicians like governor flynch, "junior" representative carol shea-porter and "jeannie" shaheen along with district 2 rep hodes. Perhaps one of them can explain why congressmen and women deserve better healthcare than the rest of us. It won't be at a face to face townhall meeting, because shaheen and carol shea-porter refuse to hold one.
- Michael Layon, Derry
Well now it appears that the President has staged yet another town hall meeting. He says the participants randomly selected. From what, a small pool of Obama campaign workers and their families? That two town hall meetings have both included such question takers is like hitting the lottery twice in a row.
I challenge any attendees of this town hall meeting to come forward who are registered Republicans and provide us with a release to obtain your voter registration record.
- Don Diamant, Milton, NH
If this passes how long will it be before the US outsources to a private insurance company to help bail hem out. If they fail to manage one billion dollars for the CARS program and outsource it to Oracle along with Citigroup, I do not expect it to be too long after.
- Moranj, New Boston
So do you think the federal govenment can run healthcare as well as they run medicare or medicade? Or the VA for that matter? We NEED the feds to bail us out? My how some are so disallusioned.
So tell me wikk the cuts to medicade make it work even better? Something does need to be done but to think the feds can run it and run it well is pretty comical.
- Bill B., Pelham
The MA program has been a disappointment because they did nothing to cut costs. It was essentially a giveaway to the health insurance companies.
- James R., Hampstead
Jonathan,
I am familiar with the MA program. The real problem isn't necessarily Fed funding, but in its implementation. Instead of decreasing costs by getting everyone insured, Commonwealth Care actually added a 4% administrative overhead. There was a failure to address the underlying cost issues with providing healthcare to the citizens.
President Obama is correct in that the current system is unsustainable. However, following the MA model would be a disaster. The complexities of why we spend about twice as much per capita than other industrialized nations can't be summarized in this quick post, but if we don't get the per capita costs in line then we are failing to address the real issue which is cost.
- Todd, Atkinson
It is fun to watch the probusiness lobby and think tanks try and surmise why private health insurance has resulted in our being 27th out of industrialized nations in quality of care. According to them, everything the government touches is awful but what they have created is much worse. Canadians live three years longer than we do on average. Our infant death rates are high. The rich love not only their health care but everything else - they are rich, after all, what's not to love? The misteak is thinking that we can continue to have what we have now. No one believes that. Do you want to get rid of Medicare and Medicaid as have the Republicanics for years along with Social Security, the FDIC etc. or do you want to try and fix it? Sorry, those are the only possibilities now. Ask your mother with what she is going to replace her Medicare.
- Robert, Deerfield
This problem is not as complex as the politicians make it. It doe snot need to be re-written. It needs reform. Turn on the TV and you see ad after ad of tort lawyers telling you you have the right to sue. These type of bogus lawsuits need to be stopped. Then give the insurance companies more health care plan choices. You pay for the coverage you want. The cost of insurance is what it is because of idiots in office forcing them to cover things that should not in everyones health plan. They cover too much, that is why we pay what we do. If all the stupid things were not in the plans than it would go down. We should be able to choose what is in our plan, not the politicians. All most of them care about is themselves which is obvious from the way they are slandering the public calling us mobsters among many others. I hope people are smart in the 2010 elections. We need to turn the tables on these ignorant Senators. They are going to vote what they want to and when they do we need to vote them out!!
- Stacey, Manchester
Everyone has their perspective on the health care reform issue. The real disturbing part of that is one person's experience should not be the driving force for an entire system. At this juncture, having the working people pay for everything in this country is just plain wrong. It always seems that the "something for nothing" crowd is running the show. Have everyone buy into an HSA, pay for their own services and stop looking to the boated government for handouts.
- Lynn G, Dover
Having just moved from MA, I can say for sure that the MA model is broken.
They offer no incentive to take care of your self. In NH I can buy a non-smokers policy - not in MA.
They also force everyone to participate in paying for things like IVF. Well, I don't want IVF and in NH I can get a policy without that.
That is the real problem with the gov't mandates - they tell you want is good for you and it ends up doubling the cost.
Now I have to figure out where to move when USA becomes like MA!!
- john, dublin
From my understanding, the Federal Government provided funding for the state governments to reinvent their respective administered Medicaid programs, which Maine and then Massachusetts opted to participate in, while New Hampshire did not. The real problem with Maine & Massachusetts' respective healthcare reform programs is that the Federal Government financed the initiative, and is now underfunding Medicaid, nevermind subsidized healthcare insurance. The state governments depend mostly on the federal government's financing for their healthcare reform programs to work, but now are cutting healthcare insurance benefits because they (the states) are not able to pay for the rising or high costs of healthcare services. That is why President Obama is proposing transitioning healthcare reform from the state to the federal level -- so the federal government will be able to finance its own healthcare insurance reform program that is not working on the state level. New Hampshire has cut many millions of dollars from Medicaid funds and needs the federal government's assistance if the state is to adequately insure its one million-plus population, especially the young, elderly, disabled and people who are suffering from physical and mental illness. NH has a broken healthcare insurance system and needs the assistance of the federal government to fix it!
- Jonathan Melle
- Jonathan Melle, Amherst
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