Is "Too Big to Fail" Finding an Echo in Massachusetts Health Care Debate?

Tuesday, January 31, 2012

In his January 23rd State of the State address, Governor Deval Patrick pushed the legislature hard to act soon on a comprehensive health care cost control bill he introduced almost a year ago, House Bill 1849, An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments.

"Before you take up next year's budget, pass health care cost containment legislation," Patrick exhorted members of the legislature, who had assembled in the House chamber to hear the address.

Budget deliberations customarily begin in April, so Patrick was trying to set a March 31 deadline for enactment of H.B. 1849. It was not the first such attempt. Last October, he challenged the legislature to take up the bill in January.

Within two days of the State of the State address, it became clear that, one, the legislature would not be voting on health care cost control before it starts working on the Fiscal Year 2012-13 budget; and, two, legislative leaders are wary of changing the health care system because so much of the Massachusetts economy rides on health care.

The State House News Service reported that Dick Moore, Senate chairman of the Health Care Financing Committee, said, "We need to be very thoughtful about moving the health care system away from the current method of paying for volume of care toward paying for value of care. We need to get this right, or it could harm one of our most successful sectors of the state's economy. I'm confident that we'll have a good plan in the coming weeks, but it will differ significantly from the bill filed last year by the governor."

Moore's counterpart, House Health Care Financing Chairman Steve Walsh, later promised, "We will be doing something this session."

There's a rule requiring the legislature to adjourn by July 31 in years when legislative elections are held. This being one of those years, Walsh was committing only to a vote in the House on health care cost control in six months' time.

While acknowledging that "an awful lot of money can be squeezed out" of the health care system, Walsh said cost-cutting "can't be done overnight" without "harming patients, hurting employment, and hurting the industry, so we have to take an approach that is very sound and very smart. We can't turn that ocean liner immediately." (Was he thinking about the Costa Concordia when it made an ill-fated course adjustment off Italy not too long ago?)

Following the governor's address, House Speaker Robert DeLeo emphasized to the media that hospitals and other health care providers "are one of the major employers of people here in the Commonwealth, so we have to be extremely careful to try to make sure we get it right. It is my hope that we get it done this year."

We often hear how costly health care is, and how much it consumes of the U.S. gross domestic product (GDP): 20% and still rising. (Fifty years ago, it barely consumed 5% of GDP.) But we don't hear as often how crucial health care is to the Massachusetts economy and how many Massachusetts jobs are in health care, so it might be good to point out now that 49,000 of our fellow citizens work in health care and that the collective health care payroll in this state tops $4.5 billion per year.

Forty-nine thousand jobs represent 15% of all employment in Massachusetts: one out of six people work in health care. Here's another figure to consider: the Massachusetts health care sector generates cumulative economic activity of between $60 billion and $70 billion annually.

When the Great Recession hit three-and-a-half years ago, we heard about some banks and financial institutions being so large that Uncle Sam couldn't allow them to succumb to bankruptcy. They were "too big to fail"! A variant of that theme now haunts the members of the Massachusetts House of Representatives and Senate. We could have a health care system "too big to shrink"?

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