James Roosevelt, Jr., President and CEO, Tufts Health Plan says Massachusetts’ achievements in health care coverage could be undermined by national reform if state and federal authorities fail to coordinate efforts:

This weekend historic legislation passed in the House of Representatives. Despite 100 years of effort, no universal coverage legislation has gotten this far before. Even though it has a long way to go in the Senate and the conference committee, and there are important elements that I do not agree with and hope will be changed, this is a momentous achievement.

There will be time in coming weeks to discuss how the bill can be improved for all Americans. Today I want to highlight some concerns unique to those of us who live and work in Massachusetts. I have been vocal in my support for national health care reform, as I believe access to health care is a human right. Nevertheless, as the president and Congress are seeking to create legislation, it is worth noting that our own state’s health care reform achievements could be undermined and that the business community, particularly small business, could be burdened with additional costs.

Last week, Lisa Wangsness, of The Boston Globe, wrote an informative piece that did a good job outlining the vulnerability of the state’s subsidies and the risks of increased costs should some of the House and Senate Reform bills pass in their current form. Read more…

James Roosevelt Jr., president and CEO, Tufts Health Plan, blames medical expenses — such as costly drugs and technology — for pricier health insurance premiums:

On Wednesday, Sept. 16, The Boston Globe published a front-page story that highlighted health insurers’ 2010 premium rate increases, which run, on average, seven to 10 percent.

This is not good news for anyone, though I was pleased to see acknowledgement that medical costs play a role in the dilemma of rising annual premiums. In the piece, local health care professionals said that rising costs are a result of greater use of medical services by aging baby boomers, costly technology and expensive drugs, while the reporter highlighted an over-reliance on Boston’s excellent medical centers as another element contributing to rising costs. All true.

Nevertheless, I will go one-step further: It is a fundamental fact that rising medical costs accelerated by our societal desire and values, which support access and medical innovation—are the primary drivers of unsustainable increases in overall health care expense. Read more…

By James Roosevelt, Jr.
President and CEO
Tufts Health Plan

It has been my privilege and good fortune to know and work with Sen. Kennedy for many years, both on politics and policy. My wife, Ann, also worked on his staff in the early 1970s, where he fostered her lifelong dedication to environmental issues by his leadership in the areas of energy policy and conservation. When I would meet her outside the Senate Office Building at the end of a very long day, Sen. Kennedy would still be at the office or just leaving the building, carrying a bulging bag of reading material in preparation for the next day’s work.

In my mind, his success in the Senate derived from his innate ability to create consensus among those with disparate points of view, and his fundamental belief that the role of government was to help its citizens. That clarity drove his actions. He remained focused on achieving an outcome that, in some way, would improve the life of an average person, and those most in need. He used his charm, his wit and his power—everything available in his arsenal—to reach his goal, which was always to make our country more humane and to ensure that America’s benefits were accessible—in equal measure—to all its citizens.

This was never truer than in his fight for universal health care coverage. I heard him tell this story when asked how he could support universal coverage that did not include the controversial single payer system. He said, “Years ago, there was a young geography teacher who had moved down to a rural area in the south, and was looking for a job. The local school board was split between evolutionists and creationists. This young man knew that he would be asked his opinion, and that his answer would decide his future. At that fateful moment in the interview when asked how he would teach his students geography, he answered, ‘I can teach it round or I can teach it flat.’”

That was Ted Kennedy. He could teach it round or teach it flat. He understood that differences could be overcome, and that what was most important was finding a better way forward. We claim him as a son of Massachusetts, but as with a select few before him, he now belongs to the nation, and there will never be another like him.

On Wednesday night, I had the good fortune to be among 164 invited participants in ABC News’ health care forum, Questions for the President: Prescription for America. The event itself was a hybrid of a news conference (with the public instead of reporters) and a White House social event.

After clearing security, attendees gathered on the White House lawn, and for a brief period listened to a Marine Corps trio, though we quickly retreated inside as the heat, humidity and insects made it too uncomfortable to congregate. I saw some people I knew and enjoyed meeting others—and all of us were excited to be there. It was a diverse group of health care providers, insurers, policy experts, medical/nursing students, human resources representatives, business people, and others from all walks of life and political points of view, all invited because we each have a vested interest in the final shape and success of a national health plan.

ABC asked us to submit a question in advance for the president. My question was, “We have real life experience in Massachusetts with success of covering nearly 98 percent of our population in less than three years without raising health care costs and without the expense and unintended consequences of a government-run plan. Why can’t the nation follow our example?” Read more…

As the country is poised for national health care reform there is increasing public discussion and interest in the topic of physician payment. To ensure that the right dialogue is taking place, we need to be explicit about the value of providers and payers sharing the same goal: alignment of financial incentives, which is based upon delivering the right care at the right time in the right place. One cannot have a conversation about alignment of financial goals, however, without addressing the opportunity to elevate quality standards for patients. It is my prediction that as national health reform comes closer to reality, we shall hear more about quality incentives in provider contracts the same way we are hearing about investment in comparative effectiveness research. This is good news for all of us.

Why is this conversation so important now? It is my belief that we are at a critical juncture as evidenced by the federal government’s attention on health care, the state’s payment reform initiatives and as part of that—the convening of the Commonwealth’s Special Commission on the Health Care Payment System, which seeks to evaluate the use of differing reimbursement models between payers and providers. Read more…

Next week I am traveling to the northern Virginia suburbs of Washington, D.C. for a panel discussion hosted by the National Commission for Quality Assurance, which is best described as the body that assesses health plan quality measures. Its credibility is unquestioned and its partnership with U.S. News & World Report results in the magazine’s eagerly anticipated annual best health plans issue, which reveals the good, the bad and the ugly among roughly 400 participating health plans.

The audience for our discussion is a national gathering of CEOs, physicians, other health insurers and legislators. Read more…

In 1993 the large national health insurance carriers contributed to the defeat of national health care reform by their association with the famous “Harry and Louise” advertising, which struck a cord with the entire country. While there are arguably many reasons for the failure of health care reform at that time, the opposition of most of the nation’s health plans helped to doom an idea whose time had not, apparently, come.

I’m pleased to report that times have changed. Last week, I represented the national association of health plans, America’s Health Insurance Plans, in a press conference in Washington to announce its series of proposals designed to support the national adoption of universal coverage.

The announcement said many things, but my quote that found its way to daily newspapers was this one, “The heart of our proposal is a public-private partnership that builds on the employer-based coverage that 170 million Americans rely on today. We have laid out a workable, realistic path to universal coverage and we want to ensure that no one falls through the cracks of our health care system because of age, health status, or income.”

While it is only the beginning of the national health reform discussion, the ideas put forth by AHIP have merit. No less an advocate than Sen. Kennedy has called for serious consideration of the AHIP proposals for a workable, realistic path to universal coverage. Read more…

As we get closer to the presidential election, the candidates will share greater details of their national health care proposals. Depending on individual political views, people can argue the merits of both positions.

Briefly, as described by Health Affairs, a policy journal, Sen. Obama’s health care proposal focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. The analysis reports that the plan greatly increases the federal regulation of private insurance and creates questions about fiscal sustainability. (His plan includes a National Health Insurance Exchange, much like the Commonwealth Health Connector like we have in Massachusetts.)

Health Affairs explains that Sen. McCain’s health plan makes employer provided health benefits taxable as income for employees and in return, gives each employee a refundable tax credit– $2500/individual and $5000/family–for those who purchase coverage. The analysis predicts increased costs to employees, reduced benefits and fewer consumer protections.

Both proposals seek to reduce administrative and medical costs in a variety of ways, but they also offer insight into a larger philosophical perspective on the role of government in the marketplace. Independent of the presidential race, however, there are opportunities today for those of us in the health care community to identify cost savings. A common, though no less staggering, statistic estimates that 30 percent of annual health care spending is unnecessary, which adds up to $600 billion annually. Read more…

For those readers who routinely follow the dialogue of the health care community, it is no surprise that on some issues of implementation of universal health care, my point of view is dramatically different than that of Dr. David Himmelstein, a vocal advocate of the single payer system. However, after reading his CommonHealth blog entry, it is clear that Dr. Himmelstein and I agree on at least two fundamental issues that have the potential to improve the nation’s health status and save significant health care dollars. One, the inappropriate and overuse of technology in health care is not good medical practice and is a major cost driver that affects all of us. And two, wellness and prevention warrant more attention and hold real promise as meaningful ways to manage health care costs and improve health status.

In a study released earlier this week, PriceWaterhouseCoopers predicts that the nation’s medical cost will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009, which is more than double the annual inflation rate. We simply must do something to address the unsustainable increases facing all of us. The timing is right for a societal shift in thinking. Read more…

Last week in this forum Dr. David Torchiana of the Massachusetts General Physicians Organization offered both support and caution regarding some of the elements of Senate President Therese Murray’s proposed health care legislation. As the discussion begins this week at the State House on S.B. 2526, I join Dr. Torchiana in applauding the Senate President and the legislature for their leadership in helping address the complexity of reining in health care costs. But it isn’t only about reining in costs; the other equally important component is maintaining the attributes that contribute to the Commonwealth’s well-deserved reputation for excellence in its providers and health plans. To my thinking, it comes down to this fundamental question, “How do we improve access to high-quality health care while keeping health care costs as affordable as possible?”

As we are all aware, the Health Reform Law has been extremely effective in expanding access to insurance coverage to more residents of the Commonwealth. That’s laudable. However, the soaring costs of health care threaten its long-term success and viability. Read more…