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The Boston Globe

Opinion

JEFF JACOBY

Mass. model of health care: Wait for it

Is Massachusetts, now in its seventh year under Chapter 58, the health care overhaul signed into law by Governor Mitt Romney in 2006, a preview of what the rest of the country can expect under Obamacare? If so, my fellow Americans, you’d better get used to waiting.

According to a national survey of approximately 1,400 medical practices in 15 major metropolitan markets, the average wait for new patients scheduling a non-emergency doctor appointment between June and November 2013 was 18.5 days. In Boston, however, patients had to wait an average of 45 days, and considerably more than that for some specialties. The wait was 66 days to see a family physician and 72 days to see a dermatologist.

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With 450 doctors per 100,000 residents, Boston has a higher ratio of physicians to population than any other metro market in the study, which was conducted by Merritt Hawkins, a Texas-based health care search and consulting firm. All other things being equal, such an abundance of providers ought to mean shorter waits for an appointment, not the longest in the country.

But all other things haven’t been equal for Massachusetts, especially since the enactment of Chapter 58. Romney accurately predicted that the law would be “a model for the nation,” and indeed it was the template of the Affordable Care Act — as President Obama and many Democrats have readily acknowledged. Which suggests that what’s happening in Boston is unlikely to stay in Boston.

“Long wait times in Boston may be driven in part by the health care reform initiative that was put in place in Massachusetts in 2006,” the new study notes. As the share of residents without health coverage has shrunk to 3 percent, “many patients in Massachusetts are encountering difficulty in accessing physicians . . . Long appointment wait times in Boston could be a precursor of what is to come nationally should some 25 million people or more eventually obtain health insurance through the ACA.”

The Massachusetts Medical Society raises similar concerns. In a statewide survey last year, it found that half of primary-care practices were not accepting new patients. Among those that were, wait times averaged 39 days for an appointment with a family physician, and 50 days for an internist. The numbers have fluctuated over the years. But the trend is clear, and disturbing: The share of family physicians and internists taking new patients has dropped by one-fifth over the last seven to nine years.

Health insurance doesn’t guarantee accessible and affordable health care, not even in the state with the nation’s highest concentration of medical providers. Through a combination of penalties, subsidies, mandates, and moral suasion, Massachusetts has succeeded in achieving near-universal insurance coverage for Bay State residents. But that doesn’t mean that those residents are getting the care they need, from the providers they prefer, at prices they can afford. Chapter 58 hasn’t brought down health-insurance premiums, as its proponents were sure it would. Nor has it saved the Commonwealth millions of dollars, freeing Beacon Hill to concentrate on other public priorities.

A statewide survey found that half of primary-care practices were not accepting new patients at all.

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Last fall, amid the disastrous rollout of the Obamacare exchanges, the president flew to Boston to defend the law in a speech at Faneuil Hall, where Romney had signed the Massachusetts legislation seven years earlier. “I’m confident these marketplaces will work,” Obama said, “because Massachusetts has shown that the model works.”

What Massachusetts really shows is that it’s possible, in a state where roughly 90 percent of population already had health insurance, to deploy an elaborate series of carrots and sticks and boost coverage levels to about 97 percent. Beyond that, as the Pioneer Institute’s health-policy analyst Joshua Archambault demonstrated in a series of eye-catching graphics at the time of Obama’s Boston visit, the experiment only confirms that health care reform is a lot easier to proclaim than to accomplish.

Romney’s law didn’t make a dent in the number of patients showing up in the state’s emergency rooms. It didn’t keep insurance premiums from racing ahead of inflation. It didn’t relieve taxpayers from having to pour hundreds of millions of dollars annually into more and more “free” care for safety-net users.

And it hasn’t made it any easier to get a doctor’s appointment without a long wait.

Andrew Dreyfus, the CEO of Blue Cross Blue Shield of Massachusetts, sometimes introduces himself to out-of-state audiences by telling them: “I am from the future.” There’s a scary thought.

Jeff Jacoby can be reached at jacoby@globe.com. Follow him on Twitter @jeff_jacoby.
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