MELISSA BLOCK, host:
Redesigning the health care system is so complicated, it's generated legislation numbering more than a thousand pages. But lawmakers do have some models around the country they can examine for guidance. In a moment, we'll hear about a public option in Arizona.
First, to the state that mandates that everyone buy insurance, Massachusetts is three years in to its experiment with universal health care. NPR's Tovia Smith checks in.
TOVIA SMITH: In many ways, advocates like to say the Massachusetts model was a success the very moment it became law. MIT Economics Professor John Gruber(ph) says it was both the moral victory and a political one.
Professor JOHN GRUBER (Economics, MIT): If Massachusetts' plan hadn't existed, a lot of (unintelligible) hearing it just can't technically be done, just won't work. We've defused that argument. It can be done. It can work.
SMITH: Under Massachusetts law, residents must prove they're insured on their tax return or face a $1,000 fine. Robert Blendon who does polls for the Harvard School of Public Health says very few residents have baulked at what is the nations first real test of an individual mandate.
Mr. ROBERT BLENDON (Harvard School of Public Health): There were fears that we were going to have another Boston Tea Party here. But most people have just gone along and have cooperated.
SMITH: Today, all but two and a half percent of Massachusetts residents are insured. That's about a third of what it used to be and it's the lowest rate in the nation. Just over half of the newly insured enrolled in plans that are heavily or totally subsidized by the state and a little less than half signed up for a health plan from work. Boston University School of Public Health Professor Allen Segar.
Professor ALLEN SEGAR (Boston University School of Public Health): The Massachusetts law has succeeded in its main aim, which was putting a plastic insurance card in hundreds of thousands of people's pockets. We've done that.
SMITH: But beyond that, says Segar, Massachusetts' success is a lot more complicated.
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SMITH: Many were hoping universal coverage would mean fewer patients using the emergency room for routine care and that would mean savings. But health care for all has not guaranteed enough doctors for all, and E.R.s like this one at Mass General are still full of patients who couldn't get in to a doctor. Dr. Alistair Khan is the hospital's chief of emergency medicine.
Dr. ALISTAIR KHAN (Chief, Emergency Medicine): These are patients who say, you know, I have a cough, I feel weak, I have been having these headaches, doctor. And so, yeah, they've gone off the work. So it's a problem.
SMITH: Another problem with Massachusetts health care for all is that it's still not quite affordable for all. The state give subsidies to the poorest residents, but there are many like 41-year-old Melinda Penta(ph) who make a bit too much to qualify for health, but too little to really afford coverage.
Ms. MELINDA PENTA: We are the middle class that can't get anything from the government. We are struggling. It's really hard on the family.
SMITH: Penta says she actually tries to avoid or delay going to the doctor because on top of the increasing premiums are the high deductible and co-pays.
Ms. PENTA: And that's not good, because I do have multiple sclerosis. So, it's something that I could end up in a wheelchair if I don't go to the doctors but I say to my husband, I'll hold off. So that's pretty sad.
SMITH: In many ways, the real test of Massachusetts health reform will be controlling costs. Lawmakers had deliberately ignored the issue in order to get the law passed, but rising cost are now threatening to bleed the program dry. So, while universal health care has lifted the threat of financial ruin from most individuals, that dark cloud is now hanging over the state and some hospitals.
Mr. TOM TRAYLOR (Vice President, Boston Medical Center): We'll be looking at loses of about $160 million that's unsustainable going forward.
SMITH: Tom Traylor is with the Boston Medical Center. He says the state is unfairly taking away money that used to help hospitals like his make up for Medicaid short falls and using it to pay for health insurance subsidies instead.
Mr. TRAYLOR: Basically, this does become a (unintelligible) issue that we have increased coverage for many which is a good thing, of course. On the other hand, we have left the safety net hospitals in a position where they won't survive to provide the services it does today.
SMITH: The state is now facing a lawsuit from the hospital and growing public concern as lawmakers tackle the issue of cost. As one analyst put it, the honeymoon is over. Inevitably, controlling cost will be tougher than extending coverage. That was about what everyone had to gain. Now it's about what some are going to have to give.
Tovia Smith, NPR News, Boston.
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