Evidence-Based Health Care Reform? Lessons From Massachusetts

In Massachusetts, where 97% of us have health insurance by mandate since 2006, we have learned a few things about health care reform.


We have learned that universal coverage does not mean universal access to a doctor. The Massachusetts Medical Society reports that there is a critical shortage of family physicians and severe shortage of internal medicine doctors. Seven physician specialties are also operating in critical or severe physician labor markets.

A recent study by the Robert Wood Johnson Foundation showed that 75% of non-emergency ER visits occurred because a regular physician was not available after hours, and half of these visits occurred because a timely appointment was unavailable. With more than half of all the doctors trained in Massachusetts leaving the state, citing the practice environment and low salary levels, and one out of every four currently practicing doctors considering a career change, it does not appear that access issues are going to improve soon.

We have also learned that mandating coverage does not decrease costs. In fact, health insurance premiums have gone up and health care expenditures have not gone down since universal coverage was mandated in Massachusetts. The cost for Commonwealth Care (the state’s low or no-cost insurance program) is five times its initial budget. Defensive medicine (medical practice aimed at reducing a physician’s likelihood of being sued), was not affected by the mandate, and is estimated to cost $1.5 billion annually in Massachusetts – actually, more than enough to pay for Commonwealth Care. Massachusetts is now looking to cut health care costs, in a collaborative fashion between hospitals, physicians and lawmakers.

Our Massachusetts health care reform is said to be the model for national reform. The health care reform bill in Congress calls for an “Agency for Healthcare Research and Quality” which will disseminate research findings to help inform the decisions of patients and providers regarding the clinical effectiveness of different medical treatments. Yet our experience in Massachusetts does not appear to be “informing” the decisions of those in Congress. There are laudable and necessary elements to the health care reform proposed, but it is far from a finished product. Our legislators know politics, but most do not know economics, few have studied medicine, and only your personal physician understands your medical needs.

It is time for the citizens of Massachusetts to inform Washington that they must look at the results – the evidence – of health care reform in the Commonwealth. We alone have a vote in the health care reform debate. You can vote for Martha Coakley, who has said she will pass the Senate bill in its current state or you can vote for Scott Brown who has said that he will take the experience of Massachusetts to Washington to help craft a better bill. Please choose wisely, and vote in the special election today. The country is watching.