MISSED DEBATING MOMENTS ON ROMNEYCARE

During this past week’s Fox News/Google Republican presidential debate, there were several “gotcha” moments. Most of them were at the expense of Gov. Rick Perry of Texas, who once again did not appear as the strongest debater and once again lost an opportunity to effectively hang the Romneycare albatross around the former Massachusetts governor’s neck.

From the perspective of a health-care provider and health-policy analyst like myself, this failure is disheartening, not because I think one frontrunner is better than the other, and not because I wanted to see a Romneycare “gotcha,” but because his health-care plan is ruinous for the state of Massachusetts much in the same way that Obamacare is ruinous for the United States. It is disheartening to see this truth buried beneath the success of one debating style over another, especially at a time when the upcoming presidential election will be a referendum not only on our failing economy, but also on the huge Obamacare entitlement that has been loaded onto the back of it.

So why do I believe that the program that then-governor Romney passed in 2006 in Massachusetts is too similar to Obamacare to be simply waved off during a debate? An important corollary: Why don’t I believe candidate Romney when he says that his first act as president will be to ask Congress to repeal the Affordable Care Act?

First of all, note the similarities between the two laws: Both mandate the purchase of insurance, and both provide or supplement that insurance for you if you can’t afford it. Both lean heavily on taxpayer support, both involve subsidies and penalties, and both decide on benefits by way of an expanded government bureaucracy.

Second, though it is true that Romneycare has extended insurance coverage from 90 percent to over 95 percent of Massachusetts citizens, this is just a partial victory, because, as I’ve maintained many times, insurance does not guarantee you access to health care. In fact, if it relies (as both Romneycare and Obamacare do) on the insurance model of overuse, in which insurance is comprehensive and easy to use — as opposed to flood insurance, which requires a real flood to submit a claim — it will clog the medical turnstiles. Missing from both models are disincentives for overuse such as high deductibles, co-pays, and large health savings accounts.

This overuse model is also extremely expensive — over $4 billion to Massachusetts taxpayers (the majority of which is shifted to the federal government in the form of expanded Medicare and Medicaid), and another $4 billion to the private sector in terms of health-insurance costs. Health-care premiums in Massachusetts have risen by 10 percent per year, higher than the national average.

With no price controls in place, expect these numbers to continue to rise. But price controls are not the answer. A recent report from the Beacon Hill Institute warns that any attempt to control prices to bring down costs will only be a further disincentive for doctors and other health-care providers — who are already struggling with clogged offices and long waiting times — to accept new patients. The Massachusetts Medical Society reported this year that fully half of internists and family practitioners are closing their practices to new patients, and waiting times of several weeks are routine for most specialties. More than half of Massachusetts primary-care doctors are turning away from Medicaid, subsidized Commonwealth Care, or Medicare.

So what does all this mean if you are a patient in Massachusetts (or any other state in the union after the full rollout of Obamacare in 2014)? It means that you may very well be standing there with your insurance card but without access to a doctor like me to see you. It means that you may have to go to the emergency room for your routine care at a time when the number of ERs across the country has decreased by 10 percent over ten years. It means that you may have to wait for hours in that ER to be treated for a cut or a fever. With all due respect, it means that you may be clogging up that ER and getting in the way of real life-threatening emergencies while jacking up the hospital’s costs.

Keep in mind that the Massachusetts Division of Health Care Finance and Policy has determined that ER visits rose by 9 percent in the state between 2004 and 2008. Romneycare as currently structured is an unsustainable model.

Consider that Romneycare is in a state rich with some of the best medical schools, doctors, and hospitals in the country. If Massachusetts can’t sustain it, what state can?

Unfortunately, the Massachusetts experience is a look into our collective future, whether Obama wins reelection or Mitt Romney unseats him. Do you believe former governor Romney when he says that his first act as president will be to will be to give Obamacare waivers to everyone, when none other than Sen. Max Baucus (D., Mont.) patterned the Senate version of the health-reform bill (which was largely adopted) after the so-called “Massachusetts model”?

If you believe it, I have some Florida swampland or Massachusetts farmland to show you.

— Marc Siegel, M.D., is an internist practicing in New York and a Fox News medical contributor. He is the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

editor’s note: This article has been amended since its initial posting.