It’s happened again. We promised we would call out anyone who repeats the false information that Massachusetts mandated insurance benefits costs $1.3 billion – 12% of all health care costs.
Today, it’s the Boston Herald’s turn to be confronted with the truth. In their editorial today, the Herald stated this as fact. Wrong. The DHCFP study actually found that mandates add at most three to four percent to the cost of coverage (study; our summary and explanation). The Herald owes its readers an apology for spreading false information.
The Herald’s article also takes issue with requiring drug coverage as part of MCC.
We continue to disagree. MCC standards should ensure that Massachusetts residents are not mandated to purchase insurance that does not meet basic quality standards. Prescription drug coverage is basic to health care – in the same way that doctors services and hospital visits are basic to health care.
Medications play an indispensable role in medical care today. They are the first line of defense in preventing and combating disease. Even people who may consider themselves healthy need access to medications, including antibiotics, allergy medications and oral contraceptives, among others. Those who suffer from chronic or acute disease rely on medications to control and combat their conditions. Access to drugs helps us maintain our health and avoid more costly care down the road. Making coverage more affordable at the expense of access to basic care is not the solution. The ultimate goal of our health reform is to expand affordable access to health care, not just insurance.
Lisa Kaplan Howe
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I certainly don’t intend to judge, PJ. I am simply saying what things look like to me: that one way or another, we are all connected and it doesn’t help to say otherwise. You don’t have to like it.
I will say that if you really can’t pay your heating bill, that counts as an reason the state will exempt you from the mandate, so you might look into that. The law may be frustrating in a lot of ways, but there is a system to try to take personal situations into account. And, if you are paying the whole cost for a health plan, without employer help, you may be eligible for state subsidies: so, in that case, that is where your subsidies would be, and Neil and I are funding that with our taxes.
Amy, no, I am not responsible for keeping others’ costs low by paying inflated rates for myself. I am currently struggling to pay for an individual health plan. Adding Rx coverage will increase my premium by $66 per month.
And I’ll say it again: It’s NONE of anyone’s business whether or not I have Rx coverage or even insurance for that matter.
Amy,
Can you help me to decide between health insurance or heat while I seek a better paying position?
Could you rent your own apartment (no utilities included) as a single person, pay for your own medical insurance IN FULL because your insurance was canceled by your employer before going out of business, and get through everyday life? Try it sometime.
Oh, I should mention that you’ll need to calculate medical insurance rates based on age 40 (and also calculate higher income tax rates as I am currently grabbing whatever freelance work I can find, and am therefore subject to the self employment tax).
Since you and Neil brought up that we are “responsible” for the well being of one another by purchasing overpriced insurance products (???),
maybe you have a theory as to why we don’t all pay the same for medical insurance. If I’m responsible for subsidizing Neil’s Rx coverage, then why isn’t Neil (and the likes of Neil) helping me out while I’m down?
Where are my subsidized rates? What if I’m unable to secure a job with coverage?
I don’t think you ought to be judging others until you’ve walked in their shoes.
I think there are two parts to this. One piece is about a risk pool and the other is about social programs.
I am a young person- not yet 26- and in very good health. I do not need most of the coverage I have- assuming, of course, that no terrible accidents or unforeseen illnesses befall me. In a very real sense, my participation in the insurance market subsidizes those who are in fact using medical services. Our premiums may be similar, and they are getting a lot more from the system right now. And, yes, I am more than happy to pay for that, because that is the only way the system works! If the only people with insurance are people who feel they need it, the risk is too concentrated and premiums shoot up, and then some people at the margin drop coverage and the premiums go up some more until you have a spiral of doom, if you will, where almost no one can afford coverage. I happily will pay premiums now to keep the spiral of doom at bay!
As to the social program element, I think I addressed that in my previous post. I believe we’re in this together, and that means I pay for stuff I don’t directly use, and get stuff I don’t directly pay for. So, yeah, I’m comfortable with that.
Amy,
Why would you want to pay for my health insurance?
If I don’t need it, don’t want it, and cannot afford it, do you realise every penny would go directly to the insurance company? And then some DORKlepto would tax it again? Is this what you truly want?
I’ve said it before, and apparently I’m going to say it again: we’re living in a society. That means that what happens to one of us comes around to affect others, one way or another, whether you explicitly notice it or not. The path that leads from Neil to you to me may be a bit circuitous (or maybe not) but rest assured, it does exist. I could hypothesize one, but I tend to be too long-winded as it is.
So, if you prefer not to contribute to the well-being of others, I hope you will abstain from visiting the public library, sending any children you may have to public school, driving on the roads or walking on the sidewalks, or putting your trash out each week to be taken away by municipal waste disposal. Actually, I don’t really hope you’ll do that, because you are a member of this society and have a right to these things.
But boy, it doesn’t do a lot of good to pretend that we’re not all in this together, when we so clearly are.
Neil, rock on.
I think neil has commonwealth confused with communism. Maybe when I am forced to pay big money for Rx coverage Neil will be able to get the mind altering drugs he so desperately needs.
Neil must be a proud recipient of MassHealth.
“Hmmm… maybe thats why we call it a Commonwealth”
And you just love it that way, don’t you? I guess you would “mandate” that I invite you over for dinner twice a week to lower your groceryy bill too!
“By requiring everyone to have drug coverage, we make sure that people with medical needs aren’t stuck with coverage that doesn’t allow them to treat their illness.”
Sorry. But the real motivation behind this is what follows:
” We spread the cost of drugs among everyone, and not just the unlucky few.”
The truth comes out. ’nuff said
Neil,
In what way, is it very much part of your business whether someone else has prescription drug coverage or not?
If I can’t afford it, don’t want it, and don’t need it, wouldn’t it be best that others pay only for those who would use it?
Neil Cronin,
I feel for you that you need expensive pharmceuticals…but until we are all on a level playing field as far as cost goes, I don’t think anyone should dictate to me that I need Rx coverage or even insurance for that matter. My coverage costs more than that of others simply because I am not fortunate enough to work for a large corporation who can negotiate reasonable rates and can afford to contribute towards their employees’ coverage. COST SHOULD NOT BE DETERMINED BY WHERE ONE WORKS.
To reiterate, Neil, it’s NONE of your business if I have Rx coverage.
Actually, PJ, it is very much part of my business whether you have prescription drug coverage or not. You see – I’m one of those who needs a lot of expensive medications – for HIV, depression, hypertension, and those ever quirky gastrointestinal problems that result from taking the above described illness required medications.
If folks like you abandon a health care insurance system that pays for medications, then the full cost of those medications must be borne by those who opt (out of necessity) for drug coverage.
This is called risk sharing. I’m grateful that the Commonwealth has chosen to stand as community of folks who will share the risks of disease treatment among all of its residents, rather than leaving the sick to carry the burdens on their own. Hmmm… maybe thats why we call it a Commonwealth.
I completely agree with MCC is a Tax…I am currently enrolled in an individual plan and I opted out of Rx coverage. The identical plan with Rx would have been $66 more per month ($352 vs $286).
This mandate is ridiculous. If I am unable to find a job which offers health benefits before my renewal next year, the same plan with Rx coverage will be in the mid to high 400s for me as my new rate will be calculated based on my having turned 40 this year.
It’s NONE of anyone’s business whether or not I have prescription drug coverage.
MCC:
You’re right that buying prescription coverage is “not worth it in most cases.”
All insurance is not worth it in most cases. The vast majority of people don’t ever have a fire. Fire insurance is just throwing away your money — unless you’re one of the unlucky few that has a fire.
For health care, 20% of the people use up 80% of the cost. So insurance is a bad deal for most. But each year it’s a different 20%, mostly. So you never know.
By requiring everyone to have drug coverage, we make sure that people with medical needs aren’t stuck with coverage that doesn’t allow them to treat their illness. We spread the cost of drugs among everyone, and not just the unlucky few.
We need to do a lot more to lower the cost of coverage, including drugs. We’re doing a lot at HCFA, but it’s never enough. But I’m confident you’ll be glad you have your wife’s BCBS coverage if you need a life-saving drug that isn’t on the Walmart list.
The Herald is correct in that the Connector is creating maximum coverage not minimum coverage. People should be able to buy coverage with and without RX coverage. Suppose someone doesn’t believe in taking any medication, and we all know people who won’t even take an aspirin, the Connector is going to force them to buy a plan that covers RX.
Let’s use your figure of 4% and that figure isn’t correct when you consider the pricing that BCBS, Tufts and HP charged for coverage with and without RX coverage. A family that pays $1000 per month in coverage will pay almost $500 per year for RX coverage. Not worth it in most cases.
Consider that Walmart has a $4 RX plan for most generics. You can buy antibiotics, Cholesterol meds, diabetes, mental health, high blood pressure, and thyroid meds for $4 for a generic. That’s cheaper than what you would pay at CVS with BCBS. Even oral contraceptives are only about $10 less per month without insurance. I bet you have never even looked to see how little insurance companies pay towards oral contraceptives. You’d be stunned as to how little insurance companies pay towards most medications.
We recently needed AMOXICILLIN. I have BCBS thru my wife’s work. If I filled it thru CVS, I would have paid $10, BCBS would have paid $.97. Yes 97 CENTS. Walmart charged me $4 for the 30 day supply. Now why exactly should I/we/your guinea pigs be forced to buy an RX plan?
This has nothing to do with basic care. This has everything to do with Connector and the state being out of touch with the rest of society. Let people buy 2 tiered coverage