Michele Walk, Associate Editor
Ideology: Moderate | Writing From: George Washington University

Contrary to the tone of the health care debate, government-run health insurance providers (“public option”) and subsidized health care are not new to the United States; a program similar to the Democrats’ health care reform plans has been operating in Massachusetts since 2006. Though it has brought to care to thousands of people who otherwise be unable to afford insurance, it has consistently run over-budget, has not led to “universal” coverage, has failed to address the systemic causes of increasing costs, and has fallen prey to immeasurable fraud and abuse.

A healthy population is vital to a sound, productive nation, and while the United States enjoys the highest standards of medical care in the entire world, it is regrettable and a blemish on the country that so many citizens are either uninsured or cannot access the care they need. Massachusetts attempted to deal with this problem in 2006 when universal health care was implemented, under Republican Governor and perennial presidential hopeful Mitt Romney. In addition to mandating that every citizen have health care, “RomneyCare” included what is currently known as a “public option,” the Massachusetts Health Insurance Connector Authority (commonly referred to as MassHealth.) MassHealth provides free coverage to people who are under 150% of the Federal Poverty Level (FPL) and partially subsidized care to those making under 300% of the FPL.  It is a remarkably similar plan to the proposals currently being discussed in Congress, especially the plan passed on Saturday by Speaker Nancy Pelosi.

Overrun emergency rooms, most visibly in the media in California, are often cited as a reason for universal coverage. Under the Emergency Medical Treatment and Labor Act of 1986, emergency care providers (ambulances and hospitals) are required to treat people regardless of their ability to pay. Though EMTLA is a beneficial law, it has caused significant burdens upon hospitals and ambulance services. Since 1986, the poor and uninsured flock to the emergency rooms for their basic care, and that has been major factor in the explosion of health care costs. Much like the law of conservation of energy in physics, there is a law of conservation of costs in economics – costs must go somewhere; they do not just disappear. Instead of the hospitals covering these costs (and passing them on to the consumer), however, now it’s the government paying for them (with your tax dollars). When it boils down to it, costs are still high, and you are still paying for it. Nothing has changed.

EMTLA also means that paramedics can’t refuse to transport someone to the hospital – even if their “emergency” is of questionable authenticity. In my personal interviews with emergency medical technicians (EMTs) in Massachusetts (who have asked to remain anonymous), it has become abundantly clear that there is widespread abuse of free health care, especially emergency care. Paramedics are frequently sent to locations assuming that a patient legitimately needs medical attention, only to find out that the person only wanted to be “taken to the grocery store or pharmacy” or want a “prescription for pain medication only so they can abuse or sell it,” in the words of one EMT who works in low-income cities such as Lawrence (famous for its mills in the Industrial Revolution). Some callers are legitimately sick, but not pressingly so and are “too lazy” to go to their primary care physician, or that they actually do need to go to the hospital, but aren’t in an emergency situation yet “don’t want to call a cab because it’s too expensive” – after all, the $1,000 plus ambulance ride, courtesy of the taxpayers, is free for them. EMTs also deal with a significant number of calls from poor/homeless drunks and drug addicts. Said one paramedic who works in the Boston area, “I’ll save a life by giving a heroin addict Narcan [drug used to counter opioid overdose], and just by making him or her breathe again I cost the taxpayers over $1,000…and it is not uncommon to repeatedly see these patients.” Some people are frequent users of emergency care because of their addictions, but others call 911 on a regular basis just for attention; the District of Columbia actually employs people to routinely visit these “frequent fliers” in order to keep them from tying up valuable resources.

Ambulance companies have to keep extra paramedics and trucks on hand because of the volume of bogus call, which increases costs for the company and in turn everyone who has a legitimate medical emergency. But after considering the widespread abuse of “free” medical care, it is not surprising that despite expanded access to primary care doctors for the poor – the often, if not always, cited reason for crowded emergency rooms – that Massachusetts still ranks 8th for most emergency room visits.

Emergency rooms, hospitals, and primary care physician’s offices are even more overcrowded than they were before, health care costs continue to rise, and MassHealth consistently goes over budget. RomneyCare failed to address these fundamental issues. Instead of increasing the incentives for physicians, young would-be doctors are scared away by the outrageous costs of malpractice insurance, which can often run in the six figures per year. Malpractice reform would not be the “magic bullet” for reducing costs, but it would bring more people into the medical field – and increasing the supply of doctors would simultaneously reduce costs and increase the quality of care. Instead, doctors and medical students in Massachusetts are fleeing primary care for specialized medicine, which often has higher pay and significantly lower insurance costs.

A major argument used to support universal healthcare plans like RomneyCare and ObamaCare is that they decrease costs. However, they “decrease costs” by subsidizing care instead of actually dealing with the systemic problems that have directly caused the higher costs in health care. That is, consumer costs are artificially decreased while the healthcare provider’s (ie, the producer) costs remain the same – and anyone who has taken a basic economics course, which apparently the majority of House Representatives have not, would know that the reason for high consumer costs is because producer costs are so high. Despite the universal health care policy (which has actually failed to cover all residents), medical costs continue to rise in the Commonwealth. Nancy Pelosi and the Democrats need to take a lesson from Massachusetts: artificial reduction of consumer costs is not a sustainable, long-term solution to the high cost of health care.

While MassHealth has brought a basic level of care to almost 500,000 citizens in the Commonwealth who otherwise could not afford it, there are significant and unignorable drawbacks to the system. Not only is the cost to taxpayers in such unstable economic times an issue, but there is blatant abuse by patients. However, I do not intend to argue that the high costs of the abuses of free care means that none of the poor should be covered, or that every single person who receives free care will abuse it. For example, with regards to the case with the heroin addict, I do not argue that the person should not be treated; rather, that there are other factors at play, such as economic disenfranchisement, poor (public) education, or lack of mental health resources that led them to be in that position and make it exceedingly difficult for them to improve their situation on their own.  In my personal view, these are larger systemic issues that factor into the high cost of health care that desperately need to be addressed.

With that said, any discussion of universal, free health care must include discussion of significant penalties (fines and even jail time) for abusing the system – something that Massachusetts’ health care reform lacked, and something the Democrats’ health care plans lack as well. A way must be devised that will severely penalize those who find it acceptable to call up 911 with bogus emergencies (without penalizing those who actually need care), or are frequent recipients of emergency care (such as drug addicts, who should be legally mandated to enter rehabilitation programs). It would not be easy to design or enforce, but it is crucial to a fiscally and pragmatically efficient policy.

Among economists there is the maxim, “there is no such thing as a free lunch” – that is, even if something appears to be free, someone along the line is paying for it. But when speaking of so-called “free” goods, there should also be the maxim that whenever something is free, it will be abused. And when it comes to a taxpayer-funded program, that abuse and waste needs to be minimized as much as possible, especially when it’s a $1.2 trillion dollar program.