Mandatory Insurance, Shoddy Results

In a recent op-ed in the Wall Street Journal, Massachusetts Governor Deval Patrick praises his state’s health care program as the right model for the entire nation to adopt. In 2006, Massachusetts passed a health care reform law that required all of its citizens to purchase health insurance. The state set up an agency to regulate the kinds of policies people could purchase from private insurers and to offer subsidized coverage to those residents who could not afford private insurance.

Patrick boasts that as a result over 97% of state residents are now covered. He claims that, “Our residents now have better access to preventive care in lower cost primary-care settings. Employers have expanded coverage for workers, not retreated as some feared. Families are less likely to be forced into bankruptcy by medical costs.”

But there is one aspect of health care that is conspicuously missing from this list- the actual quality of care residents of Massachusetts are receiving.

In reality, mandatory insurance and the subsidies that fund it have left the state’s health care system a wreck. As Dr. Paul Hsieh notes in his article “Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America,”

As a result of rising costs and falling revenues, access to medical care [in Massachusetts] has dwindled for many patients. Fewer doctors are willing to take on new patients for fear of losing even more money. Lee Sampson, a 47-year old medical transcriptionist, had to call fifty doctors’ offices before she could find one that would take her as a new patient. Tamar Lewis, a 24-year old hair stylist, called more than two dozen primary care doctors for a checkup. All of them turned her down, leaving her with no choice but to rely on the community free clinic. Patients face long waits for basic medical care—in some cases more than a year for a routine physical exam. These long waits are not due to a shortage of doctors. As the New England Journal of Medicine notes, Massachusetts “has the highest physician-to-population ratio of any state, in primary care as well as overall.” The waits are due to a government policy that discourages physicians from seeing patients—a policy under which seeing patients can mean that physicians lose rather than make money.

So when the governor touts that residents have “better access to preventive care,” what he really means is that, yes, everyone will see a primary care physician, but a year after they actually want to.

But why is this happening? Why is it not possible to mandate that everyone have insurance and still enjoy quality health care?

Dr. Hsieh answers,

The Massachusetts plan has failed for two related reasons: First, it ignores the fact that health insurance is a commodity (in the broadest sense of that term: a good or service created by businessmen for trade in the marketplace); and second, it violates individual rights. As with any other commodity, health insurance cannot be created by a government mandate. Just as the government does not and cannot create shoes by mandating “foot coverage,” so it cannot create health insurance by mandating such coverage.

In other words, mandating coverage does not equal actual care.

The Massachusetts model is very similar to the plans being proposed by Congress today, which include requirements that everyone purchase insurance, establish a government authority to provide health insurance at taxpayer expense, and dictate which kinds of insurance policies individuals can buy. When Patrick encourages policy makers in Washington to adopt his state’s health care system, he encourages them to subject their constituents to the same consequences the residents of Massachusetts are experiencing, only this time on a national scale.

Read the rest of Dr. Hsieh’s article at

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