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Obamacare foes have portrayed the VA hospital scandal as a dystopian glimpse into the future of the Affordable Care Act. The temptation is understandable if one regards health care policy as just another battlefield for partisan strife.
Not that the troubles at the Department of Veterans Affairs don't offer tough lessons for the other side. Supporters of government programs have an obligation to insist that said programs be efficiently run. Though the VA investigators have thus far failed to find evidence of the most explosive allegation - that veterans died because of waits to see doctors - the emerging stories of mismanagement and probable malfeasance are bad enough. Public programs cannot be left on cruise control.
That said, if you want to see the future of Obamacare, look not at the VA hospital system but at the Massachusetts health plan now in its eighth year. Pushed into law by former Republican Gov. Mitt Romney, Romneycare was the inspiration for Obamacare. And although Republicans now deny their paternity - so as to not be seen working with Democrats - Obamacare and Romneycare share the same conservative DNA as mapped out by The Heritage Foundation.
So turn your gaze toward Massachusetts, where Romneycare is doing just fine. How so? Let us count the ways.
1. Lower death rates for the non-elderly. A new study in the Annals of Internal Medicine found a nearly 3 percent drop in mortality for those not in Medicare after the state reforms expanded coverage. Especially interesting, the mortality rate fell 4.5 percent for those with diseases considered treatable with good medical care.
2. Healthier personal finances. In Massachusetts, credit scores rose, personal bankruptcies fell and delinquency in loan payments declined after the reforms became law. A working paper from the Federal Reserve Bank of Chicago links it all together. It's been no secret that the costs of serious illness have been the main factor driving people into bankruptcy. An analysis by the Kaiser Family Foundation found that about a third of non-elderly adults report having struggled with medical bills. Both Romneycare and Obamacare help low- and moderate-income people afford medical coverage.
3. No loss of needed medical services for the already insured. Contrary to dire predictions of "rationing," the expansion of health coverage in Massachusetts did not hurt those already holding insurance, according to a study in the journal Health Affairs. The researchers examined how many long-insured people with conditions controllable by primary care services (such as diabetes and hypertension) ended up in the hospital because their doctors became too busy handling the newly insured. For Medicare patients, who tend to have more chronic illnesses, the rate of preventable hospitalizations actually has fallen in the years since Romneycare became law. (What probably happened: Doctors identified those needing urgent care and moved them to the front of the line.)
Of course, we can't ignore the need for more primary care providers as the insured population grows. But this study does weaken the idea that Obamacare will create a crisis in health care access for those already covered. In a rich country, the cure for a primary care doctor shortage is getting more primary care doctors. And in a capitalistic country, one does that by paying these physicians more.
4. Happy people. The Massachusetts Medical Society released a poll showing about 8 in 10 residents are pleased with their health care. They do wish it were cheaper. Don't we all.
The future of Obamacare is already playing out in Massachusetts. Take a look.