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More Than a Band-Aid?

Massachusetts is rolling out its new universal health plan, and you should pay attention.

It’s apparently a big deal, judging by the weight and expense of the promotional lunchbox-size first-aid kit packed in a FedEx “Large Box” that landed with a thud on my desk here in Nashville a few weeks back. The first-aid kit was part of a promotion designed to get people like me to write about it, I suppose. To the Massachusetts Hospital Association: mission accomplished. And thanks—I’m sure the kit will come in handy when someone in the office gets a paper cut or staple in the finger. (Why a program that requires people to obtain health insurance by law needs promotion is beyond me, but that’s another matter.)

The kit proclaims: “Massachusetts Health Reform: More Than Just a Band-Aid.”

It—the health plan, not the first-aid kit—is supposed to provide coverage for about 515,000 of the state’s 550,000 uninsured, according to Moody’s Investors Service. The plan has been hailed as a solution to the problem of the uninsured in the state, a problem that leaves hospitals footing the bill for so-called uncompensated care.

The nation is watching. Why? Because such “universal” plans have been tried before—just not exactly in this way—and we’re all hoping one will work someday. The new law is a game attempt to solve the problem of the uninsured, which causes fits among hospital executives each year.

Fine for the hospitals, but what does the bill do about the root of the problem, which is the cost of healthcare?

Tennessee tried something that was supposed to cover the uninsured a few years ago: TennCare. Hospitals loved it at first, because it meant they were going to get paid for care they’d simply written off in the past. But it turns out there were multiple loopholes in the program. Some companies cut benefits and implicitly encouraged their workers to sign up for TennCare. Numbers for the uninsured dropped significantly, but numbers of poorly insured rose dramatically. Massive corruption and fraud littered the whole thing. A few people got rich, providers dropped out, the taxpayers got hosed, and the program came crashing down a couple of years ago.

Now word comes out in the Boston Globe that a key pillar of Massachusetts’ new program—that employers who don’t insure their workers will pay penalties to the state—is built on shaky ground. Penalties on such employers were supposed to bring in $95 million this fiscal year and $76 million next year to help fund the program. Now because of various problems, the state expects to collect nothing this year and only $24 million next year, according to budget officials and the newspaper.

Need a Band-Aid? I think I can spare a few.

—Philip Betbeze