How Universal Health Care May Affect Mental Health
Arguably Mitt Romney's most important success to date is the reform of the Massachusetts medical insurance system, which he hopes to expand to a nationwide effort. However, his plan does not entail expansion to the nation, as that is the exact opposite of his healthcare plan. Romney has outlined 6 steps towards more affordable and comprehensive coverage:
- Deregulate the insurance market. Romney reasonably shows that each state has a different population with different healthcare needs, and a "one size fits all" system is certain to adversely affect those at the extremes of the insurance market. The federal government will incentivize each state to deregulate (read: promote competition) among insurance providers, thus lowering the rates.
- Help the uninsured purchase private insurance. In the current system, the uninsured receive "free" care on an ad hoc basis - when they need it, they get it free. This is subsidized by taxes. Romney intends to take the same pool of money and funnel it into purchasing insurance plans for the uninsured-so rather than ad hoc healthcare being subsidized, private insurance is subsidized. By analogy: instead of taxes paying $1000 for ad hoc care in a given year, that $1000 will go towards buying the person medical insurance. The intention is that this medical insurance would be the same insurance that anyone else might buy.
- Health Savings Accounts: Basically, this is an IRA for insurance. You put pre-tax dollars in, and can use them when you need to. If you don't need to, they stay in the account until you do need them. As a small point, certain varieties of HSA in effect can be used as extensions of an IRA. If you were sick at age 70, you might use some of your saved IRA money for medical expenses, and some for rent, etc. With an HSA, the pool of retirement funds is simply "budgeted" toward medical expenses only.
- Medicaid Block Grants. Currently, money to Medicaid is specifically linked to various benefits. Romney intends to give the money as a single block, and allow each state the ability to decide how it should be spent.
- Tort Reform. If doctors are practicing defensive medicine, that will drive the costs up. By enacting a cap on damages (noneconomic and punitive) he hopes to reduce some of the "defensive" spending. (As an aside: my opinion is that doctors attribute some of their practice to "defensive" medicine, when it is often really a function of insecurity about what actually to do.)
- "Market Dynamics and Modern Technology." In other words, promote technical innovations to enhance care and reduce costs, and allow "market forces" to control some of the costs.
It's not immediately clear how this will affect psychiatry, as psychiatry has a close relationship with Medicaid programs and issues of pharmacy. Hospital stay is certain to change; there will be more varied options available (longer term residential vs. visiting nurse; acute hospitalization vs. one-day acute assessments followed by step down, etc). It is conceivable that under the Romney plan drug prices may not actually change, but coverage itself may improve. A guess as to how this may happen is that various insurance plans offer different drugs, but at full cost. Some plans may opt to provide a larger formulary at reduced prices, but what is not clear is how much influence over pharmaceutical companies and their ability to set drug prices this plan will have.