Mass: Insurance Doesn’t Lead to More Care
As did the Affordable Care Act, the Massachusetts reform incorporated substance abuse services into the essential benefits to be provided all residents. Prior to the law’s enactment, the state estimated that a half-million residents needed substance abuse treatment. Our mixed-methods exploratory study thus asked whether expanded coverage in Massachusetts led to increased addiction treatment, as indicated by admissions, services, or revenues. In fact, we observed relatively stable use of treatment services two years before and two years after the state enacted its universal health care law.
Full Health Affairs study on why expanded coverage alone will not increase treatment use.
I’m getting a little tired of hearing about so-called “health policy research” discussing whether universal coverage leads to more care; whether Health Savings Accounts result in less necessary care; and how demographic characteristics interact with the demand for medical care.
I never seem to hear about public policy reports lamenting differential demand for other consumer goods (except for fruits and vegetables). For instance, when is the last time you read reports worrying about African-American males owning pickup trucks, when it makes more economic sense for them to drive a minivan large enough to fit their family? When is the last time you heard a talking head advocate for public policy to discourage women from buying high heeled shoes in favor of shoes that are more sensible? When is the last time you read a paper on the perverse incentives of paying out-of-pocket for groceries rather than having nutrition insurance? For that matter, are there lobbyists who advocate for banning 7-11 convenience stores because they don’t stock the full range of products that all households need at competitive prices?
Why not let consumers make their own decisions based on their own preferences and priorities without pitying them; or condemning the consumer market that enabled their choices? Someone else’s priorities may seem irrational to me, but I don’t generally spend time worrying about them.
Just think about it: we defend the rights of someone to exist on a diet of alcohol, tobacco and fast food. Then public health experts lament that these same people didn’t buy health insurance to mitigate their poor lifestyle choices, and suggest taxpayers should step in and provide coverage.
Economic theory suggests that people take more risks when they enjoy the positive benefits of their choices, but someone else suffers the negative results. The logical conclusion of this theory suggests that people should be free to make choices and required to suffer the consequences.
Not surprised.
Half a million is about 8 percent of Massachusetts population. A couple of things come to mind – 8 percent/500,000 needing treatment is an awful lot of people for that state. That could be costly if a greater than expected number of those people sought treatment. Maybe the bureaucrats and pols in the state that were for the law had a good idea that there wouldn’t be a spike in treatment, so they felt it wasn’t too risky to incorporate substance abuse treatment into the state’s reform.
I have to wonder if the Massachusetts state legislature even debated including substance abuse treatment into the legislation.
Health care is sometimes treated as a “right” that we all should have an equal share of. Other times it is treated like a utility that everyone has to have, but some of us are using too much of — like water.
Basically this is a study of the results for government dependent care organizations. The bottom line is that “more of the patients admitted to publicly supported progarms…were covered by Medicaid” as opposed to safety-net programs.
So the people who needed treatment were likely already getting it, insurance or no insurance. Plus, people with substance abuse disorders tend to ignore administrative requirements, so they tended to remain uninsured, law or no law.
A subtext in the article is that copays are bad because they deter treatment.
The organizations surveyed were five “community-based” treatment organizations for 2006-2009. One was a FQHC, three were agencies that “focused on providing comprehensive additions treatment” along with other mental health services, and one primarily provided mental health services with some addiction treatment. Four of the organizations provided 30 percent of the total substance abuse admissions reported to the Bureau of Substance Abuse Services.
The ogranizations say they lost under the reform because copays are now required for many patients and they can’t collect them. Hence the article’s subtext that copays are deter treatment and that no health system that actually requires payment from those to be treated will succeed when substance abuse is in question. The article assumes that state funded substance abuse treatment actually works.
@Studebaker, the reason this situation is different is because providing care for those half-million people was employed as a compelling reason for implementing the law. If they didn’t use the care, then that wasn’t a very good rationale was it? Take a second to pause next time before you post your thesis on here.