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The Bipartisan Romney’s Massachusetts Plan Is Going To Fail !


Stanley Feld M.D., FACP,MACE

A reader asked why I am spending so much time on the Massachusetts universal healthcare plan?

It is because many states are trying to install a similar plan. There must be some deal where the government will support states that adopt such a plan. Massachusetts just collected 10.2 billion dollars extra from the Bush administration for the plans’ failure.

I believe it was a bipartisan bill because the Republicans thought they would get a political advantage over the Democrats from the bill, and the Democrats thought they would get a political advantage over the Republicans.

The Bush administration wants to shift the responsibility of universal coverage from the federal government to the states and avoid another entitlement program.

Romney was running for president at the time and wanted to do something big. The Massachusetts Democrats did not want to be against something that might make a big difference.

However, the Massachusetts healthcare plan was not thought out. Massachusetts did not control the premiums costs they promised to subsidize while putting a ceiling and floor on premiums to the consumers. They did not set appropriate incentives for employers to continue to provide healthcare to employees.

The number of enrollees was underestimated. The premiums the healthcare insurance industry was demanding increased and is inflated. Rather than the normal laws of insurance cost prevailing (the more lives insured the lower the premium cost) the opposite is happening. The cost of the healthcare system is rising in Massachusetts at a more rapid rate than in other parts of the country.

Emergency Room charges are higher than physician office visit charges for the same illness. However, in the new system family practitioners and internists are overbooked. The waiting list is at least three months.

Thousand of newly insured patients have figured out that the fastest way to see a physician is to go to the Emergency Room.

Thousands of newly insured Massachusetts residents are relying on emergency rooms for routine medical care, an expensive habit that drives up healthcare costs and thwarts a major goal of the state’s first-in-the-nation health insurance law.”

Citizens in Massachusetts are going to the emergency room at a 40% higher rate than the national average and a 20% higher rate than before  the present universal healthcare system.



The 2006 law is a mandated universal healthcare law. It requires nearly everyone to have health insurance coverage. The policy wonks hoped would ease overuse of ERs as the newly insured went instead to primary care doctors for non-urgent health needs. They cannot see their primary care doctor for months because of overuse of the system.

“Routine care in ERs is considerably more expensive than at a doctor’s office or community health center. The average charge for treating a non-emergency illness in the ER is $976, according to a 2007 report by the state Division of Health Care Finance and Policy, which estimated that the total bill for non-urgent ER care in Massachusetts exceeded $1 billion in 2005. In comparison, it costs between $84 and $164 to treat a typical ailment such as strep throat in a primary care doctor’s office, according to Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer. “

What happened? No state official thought out the perverse outcomes. No one thought to  motivate patients to save money. No one thought of teaching physicians to change their practice patterns to make room for acute medical illness. No one thought of setting up a system of education to teach patients to take care of illnesses that do not need to be seen.

What is the reason no one thought of these things? It is because no one asked practicing physicians what they thought the problems were.

John McCain doesn’t address the issue. Barack Obama’s plan for universal coverage will follow the Romney plan except it will be a federal government entitlement program. Neither the Massachusetts plan nor the presidential candidates’ healthcare plans create incentives for patients to be responsible for how they spend their healthcare dollar.