It's a Brain-Killer We Can't Wish Away: Controlling the Cost of Health Care

Friday, December 16, 2011

Five years ago, when Massachusetts made history by becoming the first state to adopt a system of universal health coverage, every mover and shaker at the State House acknowledged the system would last only if they could somehow find a way some day to control the cost of health care. Governor Deval Patrick would like that day to be in January.

"The building is full of good intentions," he told the State House News Service (SHNS) back in October. "We need action."

To show that the public wants action immediately, the governor cited a survey by the Blue Cross Blue Shield of Massachusetts Foundation indicating that 78% of respondents considered the high cost of health care to be a "crisis" or a "major problem," and that 88% described it as important for state government to deal with.

The governor filed a comprehensive proposal for health care cost containment in February of this year.

"We've had a bill pending for a year," Patrick told the SHNS. "We've been talking about and worrying about and fussing about this issue for a long time and we need action. The legislature has been working very hard at the committee level on a bill. I've been briefed on where they are. They need to move it to the floor sooner rather than later, and we need to take this up.

"My point," he continued, "is we've been at this for a long time. The consensus in the market is building in favor of moving away from fee-for-service (health care) toward 'medical homes' or global payment, basically whole-person care. And the consensus seems to be not only is that cost-effective care, but better quality care."

Legislative leaders, however, say the House and Senate will not be ready to vote on the governor's bill when the legislature reconvenes in January.

"We're not ready," Lynn Rep Steve Walsh, House chair of the Joint Committee on Health Care Financing, told the SHNS. "It's a complicated issue. It affects people's health and it's our largest employer."

Walsh added, "The governor's advocating for something he feels is important. I applaud him. But that public support he's talking about for change will erode very quickly if we don't do this right. We should not put quality or substance off to get something done quickly."

While State House leaders are focused on improving the cost structure of universal coverage, which has resulted in 98% of Massachusetts residents having some kind of health insurance, other players are sharply criticizing the system and arguing it should be replaced by a single-payer system, or "Medicare for All," as it is sometimes called.

A report issued in October by Mass-Care and Massachusetts Physicians for a National Health Program asserted that rising costs tied universal health care have hit poor and middle class families especially hard and have burdened small businesses with expenses unique to Massachusetts, thus putting them at a competitive disadvantage.

The report also found that the new system had: (a) fattened the state's health care bureaucracy, (b) made the shortage of primary care physicians worse, (c) fed the growth of high-deductible health plans, meaning consumers have paid more out of their own pockets for care every year, (d) increased the number of people who are "underinsured," and (e) created a "financial crisis" for hospitals and clinics that care mainly for low-income and minority populations.

Mass-Care and Massachusetts Physicians for a National Health Program would like a single-payer system, i.e., one funded solely by government-collected revenue, to replace the Bay State's universal coverage system, which features a patchwork of private and public insurance products and rests on a mandate on all adults to obtain coverage, the same mandate found in President Obama's national health care reform bill of 2009, the Patient Protection and Affordable Care Act, and yes, the same mandate that White House-hungry Republicans will not stop shedding I-fear-for-the-future-of-my-country, crocodile tears over.

Yesterday, there was a hearing at the State House on four bills touching upon single-payer health care, including An Act Establishing Medicare for All in Massachusetts, sponsored by Senator James Eldridge, Democrat of Acton, and several other legislators. Everyone who spoke during the three-hour-long hearing was in favor of the bill, suggesting that most Libertarians, Tea Partiers and Republicans had better things to do that day, like Christmas New Hampshire.

Dr. Leo Stollbach testified to the growing support among physicians here for single-payer health care. Today, he said, 41% of Massachusetts Medical Society members favor such a system; two years ago, that figure was 34%. So the new world of Massachusetts health care, born in 2006 during Mitt Romney's governorship and destined to serve as Obama's template in 2009, hasn't made the docs a whole lot happier. (Question: Is an unhappy doc a less-effective caregiver?)

The most significant witness of the day, in my opinion, was Senator Dan Wolf, Democrat of Harwich, one of the most successful capitalists to serve in the Massachusetts legislature in modern times. As co-founder 24 years ago of Cape Air, a regional air line that cornered the market on summertime air travel to the Cape and Islands and currently employs more than a thousand people, Wolf could give lessons in entrepreneurism and job creation to Romney. One of the big reasons Wolf wants single-payer in Massachusetts is the liberating effect it would have on the small businesses that create by far the largest share of new jobs.

"The biggest single inhibitor, the biggest ball and chain around small business growth is the cost and complexity of health care," Wolf told his colleagues.

If a guy who built an airline can see that, why can't the Bain consultants and their ilk see it?

NEXT: Waste in Health Care Spending

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