fallout from universal coverage

Two years ago Massachusetts mandated that all in-state residents carry some form of health care coverage, and since then nearly 300,000 of the uninsured have become insured. Now the Boston Globe is reporting on one consequence of universal coverage: a considerably longer wait for those who want to see a specialist in Boston, where the average delay for non-urgent visits is 50 days. No joke. That’s weeks longer than anywhere else in the U.S.

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It’s a good lesson that universal health care will mean a lot more people seeking health services, at least in the short term. That’s going to put greater pressure on health care providers and, of course, increase health care costs.

And the Massachusetts example shows that universal coverage may bring about certain forms of rationing in health care. Which has given some legislators cause to sound the old alarms about government-sponsored health care leading to socialism. That’s just rhetoric, David Leonhardt wrote in yesterday’s Times. I agree. We experience rationing under our current system; I’ve seen it for years in my clinical practice. For example, some patients can get adequate, timely care and others simply can’t. That’s rationing, and it’s based on a person’s insurance status. It doesn’t help that there are more drugs and other technologies available than there are dollars to pay for them, either.

The rub is that while some of those therapies are true advances, others are no better than cheaper, long-established medications and treatments. But cost-effectiveness — big topic, let’s go there some other time.


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