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Why Romneycare’s Failure Haunts Us Still

When Mitt Romney ran away from his signature legislative achievement — Romneycare — in the last presidential cycle, I was not surprised.

The 2006 health care reform bill entitled, “An Act Providing Access to Affordable, Quality, Accountable Health Care,” led to huge tax increases after Romney left the governor’s office.

Blue Cross Blue Shield of Massachusetts Foundation has done an annual survey of non-elderly adults, called the Massachusetts Health Reform Survey (MHRS), ever since. The survey has tracked changes in the health care system in the Commonwealth. The most recent survey with results from 2015 was just released.

The reason we must note the results of this non-partisan study? At the end of the day, there is little difference between Romneycare and Obamacare. Romneycare has simply gotten a several-year head start.

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Here is what the 2015 MHRS provides: a first assessment of the state’s efforts to improve the affordability of care and reduce health care spending through cost containment legislation. It also assesses the impact of the federal Affordable Care Act (ACA) that began in January 2014.

The results show that while nearly all Massachusetts adults have health insurance, being insured is no guarantee that patients can afford health care or even find someone to provide it. This is no surprise. As with Obamacare, the architects of the law deliberately focused on coverage rather than costs, in order to get it passed.

The MHRS also shows that access to care remains problematic for a significant share of residents across the entire range of income.

Forty-three percent said that in 2015, health care costs had caused problems for them and their families, including 19 percent who went without needed care as a result. The problem was more severe among low- and moderate-income adults and people with health problems.

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But the study shows that if you are low income, it’s harder to find providers who accept your type of coverage. Low-income people are often eligible for Mass Health, which in most cases does not have copays and deductibles.

Yet help with premiums still doesn’t solve the problem of high deductibles and copays.

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The survey also pointed to problems accessing care. Among adults who had insurance for the entire previous year, 47 percent said they’d had trouble seeing a health care professional. This was because they could not find a provider who accepted their insurance or accepted new patients, or because they couldn’t get an appointment as soon as needed. This problem has worsened over time.

Nearly 86 percent said they had a place where they usually go for care. Even so, one-third of respondents reported visiting a hospital emergency department at least once in the previous year — half for a condition that was not an emergency.

Why are people having trouble getting medical appointments in a state with so many physicians?

Many doctors don’t work full-time in patient care. Instead, they are pursuing research and teaching. Additionally, the problem varies by region, with doctor shortages in Western and Southeastern Massachusetts and on Cape Cod.

Another issue is the shortage, nationally and locally, of primary care doctors, who are the entry point to health care. Doctors with huge medical school debts often prefer higher-paying specialties, and general practice is lower paying, demanding and relatively unglamorous.

No one can deny the U.S. health care system needs reform. Too many Americans lack health insurance and/or are unable to afford the best care. But more must be done to lower health care costs and increase access to care. The system is riddled with waste, and quality of care is uneven. Government health care programs like Medicare and Medicaid threaten future generations with an enormous burden of debt and taxes.

But, as Massachusetts has shown us, mandating insurance, restricting individual choice, expanding subsidies, and increasing government control aren’t going to solve those problems. A mandate imposes a substantial cost in terms of individual choice but is almost certainly unenforceable and will not achieve its goal of universal coverage. Subsidies may increase coverage, but will almost always cost more than projected and will impose substantial costs on taxpayers. Increased regulations will drive up costs and limit consumer choice.

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Over the long term, the way to reduce the ranks of the uninsured is to make health insurance more affordable. It means reforming Medicare and Medicaid so these programs don’t incentivize wasteful health spending. It means lowering prescription drug costs to all payers — government, private insurers and patients by instituting “most favored nation” status so all U.S. consumers pay at most the lowest price of any OECD country. It means “site neutral reimbursement” so that physician prices for any medical good or service are the same regardless of where it is provided. And it will require “balanced” billing to reflect the true regional costs of care.

Controlling costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace — not in mandates, subsidies, and regulation. The hero of “The Big Short” — a recent film about the financial crisis — was an ex-physician, a genius who left medicine to speculate in stocks and bonds and successfully “diagnosed” the subprime mortgage crisis before anyone else.

Unfortunately, it may be a harbinger of things to come, as so-called “reforms” to our health care system drive providers out of the system and increase costs for patients and other consumers — instead of reducing them, as the politicians and bureaucrats promise.

Obamacare has only begun to drive up costs and reduce services. But there is increasing evidence from Romneycare — which was the model for Obamacare — that the problem will get worse. That is the lesson we should be drawing from the failure of Romneycare before it is too late.

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Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC.