Bloggers for the non-profit consumers group Health Care for All offer a clear overview of last week’s payment reform hearing before the legislature’s committee on health care financing. The piece reviews testimony from most of the major interest groups and shows how complex reforming the payment system will be.
At the same time, WBUR reports that the number of people enrolled in MassHealth — the state’s Medicaid program — has grown beyond projections, to over 1.2 million.
NPR’s piece today by Alix Spiegal examines the “modern” patient who marches into the doctor’s office requesting the latest medications and procedures. But is this consumer-driven care good for medicine? Or is it merely driving up costs?
A separate discussion, on WBUR’s Here & Now, dissects the politics of a new report distributed by the health insurance industry — on the eve of a U.S. Senate committee vote on the heath care overhaul — that claims premiums will increase dramatically if the reform bill becomes law.
And here’s the New York Times on the White House and Democrats response to the industry report. Also, in The Times, MIT health care economist Jon Gruber reveals deep flaws in the report.
WBUR’s Sacha Pfeiffer attended the legislature’s first public hearing on revamping the way doctors and hospitals are paid in Massachusetts. Here’s a brief report:
Several leaders of the state’s health care reform effort testified today at a hearing before the joint commission on health care financing, chaired by Sen. Richard Moore, urging legislators to reform the medical payment process in Massachusetts as quickly as possible. Many of them voiced support for a proposal, made earlier this year by a state commission on payment reform, to radically change how insurers pay doctors and hospitals.
Called “global payments,” the plan would set a fixed payment for each patient that would cover all of that patient’s care for a whole year. The commission recommended that global payments replace the current system, in which doctors receive a fee for every service they provide — an approach that critics say drives up health care costs unnecessarily by providing a financial incentive to do more.
Citing “unsupportable premium increases” and rapidly rising health care costs, Dolores Mitchell, executive director of the state’s Group Insurance Commission, cautioned that “we don’t have time to waste.” Her concerns were echoed by Dr. Mario Motta, president of the Massachusetts Medical Society, who warned that health care costs in the state have “become unaffordable and unsustainable.”
Rick Lopez, Chief Physician Executive of Atrius Health, a strong proponent of reform, testified that “global payments are not a radical new idea but rather a revival of the best of managed care combined with the many lessons we learned back in the 1980’s and 1990’s.”
The commission that recommended shifting to a statewide “global payments” system has suggested phasing in the new approach over five years. Massachusetts Secretary of Administration and Finance Leslie Kirwan, who leaves her post tomorrow for a new job at Harvard University, said she considers the five-year plan reasonable but the transition must be “careful and structured” to keep disruption to a minimum.
For more on the hearings, read the State House News Service story here. For those with extraordinary stamina, CommonHealth expects to post video of the entire hearing when it becomes available.
NPR’s All Things Considered ran an excellent story today called “The Telltale Wombs of Lewiston, Maine,” about the extraordinarily high rate of hysterectomies performed on the women in that town. (If the trend continued, 70% of Lewiston women would have their uterus removed.) But more than that, the piece offers insight into how doctors often make decisions about medical care not only based on science and evidence, but also on the quirks of local medical culture, how many other doctors there are in town, and, of course, money. Reporter Alix Spiegal notes:
Talking to doctors about money is difficult. It’s uncomfortable both for patients and for doctors to think that this most important and intimate service could be contaminated. But the truth is the decisions made by your physician when you enter his office are profoundly influenced by the way that doctors get paid in this country. “That’s just common sense. That’s human nature,” says Smith of the Maine Medical Association. “The payment system is an important influence.”
Most of the doctors in this country are not on a salary but are paid basically like pieceworkers in a clothing factory. This is called “fee for service,” and the way it affects doctor behavior is clear. “If you pay people more, the more things they do, they’re going to do more things,” says Smith.
The U.S. health care payment system rewards doctors for taking action and doing procedures. This reality is so powerful that it hasn’t just changed the individual behavior of doctors. Keller says that the specialties themselves have changed, bending like flowers to the sun, moving toward the source of heat.
Despite town hall meetings, national addresses, and campaign-style appeals across the country, the public feels “profoundly” left out of the national debate on health care reform, according to a new poll by NPR, the Kaiser Family Foundation and the Harvard School of Public Health.
“Most people don’t feel that they personally have a voice in this debate,” said Mollyann Brodie, director of public opinion and survey research for the Kaiser Family Foundation. “In fact, 71 percent told us that Congress was paying too little attention to what people like them were saying.”
“Are you Covered?” a joint venture between NPR and Kaiser Health News today looks at “The Underinsured,” families with health insurance, but still struggling to pay off medical bills due to high premiums and the cost of care.
Why haven’t emergency room visits in Massachusetts dropped now that we have near universal coverage? WBUR’s Sacha Pfeiffer reports that even people with health insurance still rely on the ER because they may not have easy access to care.
Check out WBUR’s coverage of the appointment of Paul Kirk as interim U.S. Senator to fill the seat of Ted Kennedy. John Kerry says Kirk “will hit the ground running,” and has “a special kinship for Ted Kennedy’s values.”
Indeed, the Globe reports today that Kennedy named Kirk as the executor of his estate. And WBUR looks at the GOP’s challenge to the legality of the appointment.
WBUR’s Curt Nickisch reveals a new problem in the workplace: “presenteeism,” in which sick employees show up for work because they can’t afford to do otherwise. This does not bode well for businesses in Massachusetts as they gear up for a tough flu season.
Time Magazine explores the “young, invincible” and uninsured in a big feature story this week that focuses on the 13 million Americans age 19 to 29 without health insurance, and the problems this creates for the whole system.