The increasing cost of providing care to the uninsured is making health industry and health reform insiders nervous. Some suggest that they want to “control costs” by increasing insurance costs for the working poor. For them, cost shifting to the backs of the working poor and uninsured may give them more control, but it certainly does not constitute cutting the cost of health reform. Here are two current examples of Connector doublespeak on cost containment vs. cost shifting:
Example #1: There are more uninsured than the Romney Administration projected. There are more people signing up for CommCare than expected. We might have a cost problem because of this. So, as the Connector Board is preparing to bargain with the insurance plans that are covering this population, we are being asked to prepare for a fight of “cost containment”. Last month, at the Board meeting, hidden in a slide show were bullets that mentioned the possibility of higher premiums, co-pays or cuts in benefits. While expecting people to pay higher premiums or limiting some benefits is controlling costs for the state (who strongly subsidizes CommCare), it is also shifting costs to consumers who sign up for CommCare. The cost problem of an increased number of uninsured cannot just be shifted onto those least able to pay.
Example #2: Everyone agrees that in today’s medicine, prescription drugs are an essential part of treatment for many diseases. That is why the Connector has voted to include drug coverage as part of every health plan in the Commonwealth. In turn, the business community is rightfully worried about the cost of this benefit.
Last month, when the Connector debated alternative “cost effective” plans for drugs, the debate wasn’t really about cost control. We all agreed that encouraging generic drug use is more cost effective, and can save a lot of money. What we disagreed on was how high the deductible should be, and what drugs should be covered before the deductible. Translation: How much of the cost were we willing to shift to consumers who need to use brand drugs? If we ask the consumer to pay a higher deductible, the employer will pay less for the benefit. This is another example of cost shifting being talked about as if it was cost control.
The language we use can cloud a problem, or mislead the public. Industry and government leaders should not use doublespeak, in the style of the novel 1984, to fool consumers in 2007. We need to speak the truth and not build a false Ministry of Cost Control when what is being promoted is a new Ministry of Cost Shifting.
Let’s tell the truth. If we have a cost problem, let’s figure out how to reign in costs. But we need to all be part of that solution (providers, insurers, government, business, and the consumer), and not continue to shift the costs to each other.
Celia Wcislo is a member of the Connector board
and Assistant Division Director, 1199 SEIU
Interesting that a member of the Connector Board is also an official of a union that is also seeking to extract more money out of area hospitals in the form of increased wages and benefits. And here she is looking for more money for these very same hospitals in the name of protecting the less fortunate. That’s called a conflict of interest in most states…but it’s “advocacy” here in Massachusetts…very Orwellian, don’t you think?
Yes, let’s tell the truth.
Tim,
It may shock Celia for me to agree with her about something, but I don’t think we should put her union’s aspirations for hospital workers in the middle of this issue. Everybody I know in management positions in the hospitals wants to provide an excellent work environment for the staff, including good wages and benefits. While Celia and hospital management people might differ on how we best achieve that — i.e, unionization versus not unionization — we all want good employment conditions for workers. We shouldn’t sacrifice that goal to meet the broader cost containment and access goals needed in the state.
(Of course, if unions were likely to force hospitals to sign contracts that contained work rules that increased inefficiency, delayed quality improvements, diverted Massachusetts funds to national lobbying or organizing efforts, or have other adverse affects on hospital operations, then your point is right on target.)
Senate President Terry Murray had some excellent ideas about how to start to control costs and improve quality in the health care sector. Her ideas are squarely in the arena of state jurisdiction and deserve attention by all of us.
What I find more troubling about Celia’s post is the impression it gives of being an outsider on the Connector Board while she sits on that same Board. To use language like “hidden in a slide show” and “Connector doublespeak” seems to me to be disrepectful of the staff and Board. Given her valuable participation on the Board to date, I can’t imagine that Celia would want to leave that impression. (And, by the way, how is something hidden in a slide show if it is there for all to see?) Maybe she would want to elaborate.
Paul,
Point well taken. But the fact that a health care union official is making decisions about what constitutes “insurance” in Massachusetts, which directly affects the bottom line of the employers she’s negotiating with, strikes me as an apparent, if not an actual, conflict of interest. More troubling is the fact that her union members work for the dominant hospital-based MCO in the Commonwealth Care program, Boston Medical Center. And she votes on the contracts between the state and that hospital/MCO. Is that not a conflict, or am I missing something?
As for cost sharing, of course providers (e.g., hospitals) agree with unions and self-proclaimed “advocates” on the need to load costs onto the premium and limit any real cost sharing. Providers loathe cost-sharing because (a) they have to collect payments from two sources — insurers and the actual people receiving the service, (b) it actually makes people think twice before receiving care, and (c) it might lead to a conversation between the person receiving the care and the person providing the care about that horrible five-letter word…PRICE.
Question — when’s the last time you asked your provider how much something cost? Answer (for 99.9% of MA residents) — Never.
Your interests are perfectly aligned. Why else would the Mass Hospital Assn. lock arms with Health Care for All in opposition to any type of cost sharing that might cause someone to ask…do I really need this MRI? Do I really need to go to the ER? Can I get this test done somewhere else for less? How much does this actually cost?
Just a guess, but I’m thinking the folks that scream the most about point-of-service cost sharing and want everything loaded onto the premium have never had to purchase health insurance on their own, and fail to grasp the reality of the market…namely, when someone else is paying for it, you have little reason to limit your use. See “open bar,” for example.
Until we apply to health care the same market principles that work so well in every other industry, we will continue to be “shocked and awed” that costs keep going up and up and up.
But for folks in the industry, that’s probably a good thing.
(1) “namely, when someone else is paying for it, you have little reason to limit your use”
That is the MOST ridiculous argument in current circulation!
It may, and does, apply to chocolate candy. It does NOT apply to colonoscopies, xrays,surgery or pneumonia.
Being poked, prodded, stuck with needles and patronized by medical staff (the ‘we knowbest’ attitude’) is not an eperience which anyone would voluntarily choose to undergo unless there was a necssity. Medical care is not good or service that is consumed for enjoyment or pleasure.
(2) “any type of cost sharing that might cause someone to ask…do I really need this MRI? Do I really need to go to the ER? Can I get this test done somewhere else for less? How much does this actually cost?”
This writer specializes in being ridiculous. 99% of patients are in no position to judge “whether {they} need this MRI” once their physician has said the test should be done. The layperson untrained in medicine is supposed to give a second opinion about their physician’s recommedation? They are supposd to know what providers perform various tests, their experience and accuracy rate, and whether the provider will report the results to their physician in a timely manner?
Then there is the question of how on earth they are to ascertain the ‘cost’ of a test or procedure. If they have coverage, what the ‘cost’ will be is determined by the insurer’s reimbursement rate. I tried to do that once. I called my insurer and sak what the reimburesement and charge rates were for a proceedure since I have cost sharing (% type.) They blithely said “oh, we can’t tell you that. Your provier knows what we will pay.”
And, of course, the unanswerable question is how is a consumer suppose to find the ‘best price’ if (1) they need emergency care or (2) are in an area with few providers.
Anyone who has lived with (1) being uninsured or (2) having a high deductible (defined as over $500) knows exactly what the burden of point-of-service costs are – they avoid getting care. They avoid getting care even when necessary (prescriptions, specialist referrals when ordered, tests….) to the point of 2-3 times the rate of those with comprehensive coverage and modest copays. The consequence of the lack of care is 18,000 people die every year from treatable conditions.
What is a catastrophic expense depends upon one’s income. A household with $100,000 a year can handle a $5000 medical bill. For a household with $30,000 a year new glasses for 2 people at $400-500 per person is a catastrophic.
Tim,
Enough with the MRI example. Talk to anyone with a mild injury that escalated to a serious injury and they’ll tell you that they did NOT receive a timely MRI.
Rather, PCPs in those first critical patient encounters are loathe to order the dreaded MRIs –particularly when a patient isn’t sophisticated enough to inquire about one.
Instead, the PCPs guess (well-intentioned) at the extent of a patient’s injury, swiftly prescribe heavy duty muscle relaxers and pain killers, tell you to try heat or ice (whichever works – you figure it out) and wish you good luck. Then they win awards for “controlling utilization.”
THIS IS A PROBLEM! Two weeks later, the patient needs: 1)emergency department visit for a severe injury (that could have been prevented if properly diagnosed); 2) expensive specialty care; 3)oh yeah, the dreaded MRI; 4)more heavy duty drugs, 5)surgery; 6)physical therapy; and 7) use of your company’s short-term or long-term leave policy.
A well-timed MRI/image of an injury can actually dictate a timely, conservative and cost-effective course of treatment in the long run.
Maybe we need more competition in the MRI industry to bring the costs down.
My 2 sons, both recent college graduates were not allowed to stay on my health insurance at a Fortune 100 company because my company is SELF-INSURED, while my husband’s small company was compelled to offer insurance for employees’ uninsured dependents until age 26 by state law because his company has an actual health policy. The irony here is that one of my sons does not have health insurance and signed up for a CommCare Plan. Since his income last year was $17,000 he pays a small subsidized premium for a $2000 deductible policy. Since he clears about $13,000 a year after payroll taxes and our progressive state income tax, he now pays all his own dental, eyeglasses plus the premium towards his healthcare. My son stated to me that he would NEVER use the health insurance policy because he was terrified to incur any more medical expense. The $800 he paid for dental care and the $350.00 for eye exam & glasses was all the medical expense he could stand this year, thus he skipped his annual checkup. As far as overuse of an MRI machine or trips to the ER? Really, what world is that blogger living in? An ER visit for a possessor of a COMMCARE policy would undoubtedly trigger at least a $1000 bill. He is trying to pay his student loans, my husband is trying to provide family plans for employees with dependents and the Fortune 100 company gets completely off the hook. Who’s getting stuck here? What is the Commonwealth going to do about these multi-national companies who are self-insured as far as paying their fare share and burden here. How about a little cost sharing on their end.
MRI issue…medicare pays $300 for mri of knee, any joint here in my southern rural state. Hospital gets paid $600 to $1000. About patient not knowing…Here is how I present it…you have had an injury, you are still walking, you are 40% better you state, it has been one month…your options are to get an MRI of the knee, or we can wait and if you continue to get better each week, not get one; if you worsen or not a lot better in 2 to 3 weeks, then we will get it.
Probably 70% of the people end up getting one because guess what…they’ve got something torn!!!
All the delays in the world, and all the primary care visits in the world, is not going to heal a meniscus that is badly torn. Not ordering tests is hiding pathology!!!!!! and the truth!!!!!! I say cut the payments on MRI, etc. but not the tests! All the precerts, PT, Primary care visits, etc. adds to the costs of medicine in my opinion. Get the person to the expert, and get the test and the real diagnosis, as quickly as possible, and then the patient can get started on treatment as soon as possible…PT can be much more expensive than surgery! Nonop treatment can be more expensive…traction in hospital beds for weeks for fractures, etc. Public health officials have no common sense or clue about what happens out here in the trenches taking care of the masses with injuries and disorders. My 2 cents.