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Ending the Insanity of Failed State Health Insurance Reforms

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Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.


Ending the Insanity of Failed State Health Insurance Reforms

March 2009

Sidney M. Wolfe, M.D.

Albert Einstein once said, “The definition of insanity is doing the same thing over and over again and expecting different results.”

In this case, the insanity of doing the same thing over and over again and expecting different results is the 20-year history of state health insurance reform legislation in the United States, detailed in the report included in this issue of Health Letter, involving nine different states. Although these reforms differed in detail, they shared common elements. All states offered new public subsidies or expanded Medicaid for poor and near-poor people. All left the majority of private health insurance arrangements undisturbed. As the state charts in the report document, all of these failed to have a lasting effect on the problems of uninsured people in those states.

State experiments are an important way of trying out programs which, if they succeed, can go national. In this country, Wisconsin programs for social security were an important predecessor to the Federal Social Security Act in 1935. But if they repeatedly fail, to keep experimenting on the people in those states by repeating the same set of mistakes, let alone using this private-public model for national health insurance, is nothing short of Einstein’s definition of insanity.

It should not take a psychiatrist to diagnose or treat this insanity. Roll back the clock to 1962 when, in the Canadian province of Saskatchewan, there was a similar problem of many uninsured people, private health insurance companies for those wealthy enough to afford such insurance and the quandary of what to do. Saskatchewan enacted a single payer health insurance system in that year and, after nine years of very positive results; the system was instituted for all of Canada.

The major difference between the Canadian system and ours is the enormous cost savings in Canada of eliminating the private health insurance industry and all of the administrative waste it foists on doctors, hospitals and other health providers. Today’s report estimates that a single-payer system of non-profit national health insurance could save $8-$10 billion annually in Massachusetts alone through reduced administrative costs. This is an amount far in excess of the rapidly-escalating annual cost ($1.3 billion in fiscal 2009) of the Massachusetts plan. Unlike the current plan, which robs Peter to pay Paul by taking money away from critical safety net programs in order to provide health insurance for others, money freed up because of a single payer plan could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance with large copayment and deductibles, without any increase in total health care costs.

It is time to wake up from this insanity, not impose multiply-failed state health insurance programs on everyone in the country and enact single payer health insurance for all.