Legos, Red Sox, and Those Long Waits in Massachusetts

By Jonathan Cohn - 7.7.09

A video featuring Legos, a shout-out to the Boston Red Sox, and analysis of health care reform has been circulating on the Internet. It comes via Jonah Goldberg at National Review and, I must say, it is extremely entertaining:

[See original post for video: http://blogs.tnr.com/tnr/blogs/the_treatment/archive/2009/07/07/can-a-pro-red-sox-video-with-legos-be-wrong-sadly-yes.aspx]

But does the video give us a good idea of what health care reform would look like? Not really.

Here's a distilled verison of the video's argument:

1. People in Massachusetts wait a long time to see a doctor. People in Georgia don't.
2. People in Massachusetts also pay a lot for health insurance. People in Georgia don't.
3. Massachusetts in 2006 passed reforms giving almost everybody health insurance. Georgia didn't.
4. Those reforms are the reason people in Massachusetts pay so much for their health insurance and wait so long to see the doctor.
5. President Obama wants to pass national reforms that resemble the Massachusetts state reforms.
   
6. If President Obama gets his way, all Americans will end up like those cursed people in Massachusetts--paying more for health insurance, waiting longer for care, and, I guess, watching helplessly as their lego figures spontaneously lose their adorable plastic heads.
   

Q.E.D.

The video isn't the only source of such reasoning. Lots of conservatives point to the high insurance prices and long waits in Massachusetts to suggest that reform is a bad idea. So let's take a closer look at those arguments, shall we?

(Including rest of article here instead of in comments - blog is not letting me post comments)

The suggestion that the 2006 health reform jacked up the price of health insurance misses one inconvenient fact: Insurance in Massachusetts was among the nation's most expensive long before the law took effect. There are a variety of reasons for that. The higher cost of living in New England has something to do with it. So does the heavy concentration of teaching hospitals. (Research suggests that when you have a lot of high-tech hospitals in an area, it tends to create greater demand for high-tech medical services, which drives up insurance for everybody.)

To be sure, Massachusetts has a history of regulating insurance aggresively, at least relative to places like Georgia. And such regulation can, under some circumstances, drive up the price of insurance (in part because it forces insurers to provide better coverage). But even to the extent that's the reason for the high prices in Massachusetts--and, to be clear, it would be one of many factors--that regulation also predated the 2006 reforms.

The waiting time issue is a bit more complicated. Intuitively, it makes sense that giving more people insurance would lead many of those people to see the doctor, crowding the proverbial waiting room and creating long delays for appointments. And there have been widespread anecdotal reports that reform in Massachusetts did just that. But the statistical evidence to support this thesis turns out to be pretty thin.

Consider a recent consulting report by Merritt Hawkins and Associates. Based on a telephone survey of physicians, it found that the average waiting time to see doctors in five medical specialties--cardiology, orthopedics, dermatology, obstetrics/gynecology, and family practice--were longer in the Boston area than any other city surveyed. The precise figure for Boston, 49.6 days, is presumably the source for the 50 days in the video. By contrast, the city with the shortest waits--Atlanta--had just 11 days. I assume that's why the video uses Georgia as its basis for comparison.

But hold on a second. Is there evidence that the Massachusetts health insurance reforms are the reason for the delay? Merritt Hawkins raised that as a possibility in its report--and, again, it's a plausible explanation. But the full survey details don't actually show that: Although Boston has the longest wait times now, it also had the longest wait times back in 2004, the last time Merritt Hawkins asked these questions.

Nor has Boston experienced unusually large increases in waiting times during that period. The delays in Houston, for example, also rose during this period. But there's been no similar expansion of insurance coverage there. For one specialty, obstetrics-gynecology, the wait times in Houston more than doubled--from 20 days to 41 days--which is higher, in percentage terms, than the increase for any Boston specialty.

Oh, and the survey itself isn't the most scientific. In no single city did Merritt Hawkins get more than 20 responses. The results for Boston are based on the response of 18 offices. That's an awfully small sample size--the type from which any sweeping conclusion ought to be immediately suspect.

To be sure, the Merritt Hawkns report isn't the first to suggest reforms led to longer waiting times. A 2008 study by the Massachusetts Medical Society also reported that waiting times grew after the state's health reforms. That study has been cited repeatedly in the press.

But there, too, the data doesn't live up to the hype. The figure that got all the media attention was a comparison of wait times between 2006, when the average wait for an internist was 33 days, and 2008, when the aveage wait was 50 days. But the wait times in both 2005 and 2007 were 47 and 53 days respectively. In other words, the wait time for internist appointments has basically remained stable, at around 50 days, since 2005. The low 2006 number appears to be a statistical anomaly, the sort you might expect from yet another physician phone survey with a modest sample size.

And that's not all. As with the Merritt Hawkins study, the picture gets even more muddy if you go deeper into the report. The Mass Medical Society looked at a wide variety of specialties. Waiting times for about half of them actually went down after the reforms were put in place.

Again, I wouldn't rule out the possibility that reforms did increase the demand for medical services, at least in the short term, leading to longer waits for care. (Healthcare Economist has some smart thinking along these lines.) But the idea that reform massively overwhelmed doctors and hospitals in Massachusetts just isn't supported by these reports--or any other data I've seen.

It's still a funny video, though.

Note: This item will undoubtedly earn me grief from my nine-year-old son, whose love for legos is rivaled only by his worship of all things Red Sox--something he gets from his Dad.

--Jonathan Cohn