If health spending continues to rise, Massachusetts’ health reform has no hope of long term success.
Every year, costs rise far faster than inflation, making health insurance less affordable for individuals, and tempting employers to stop offering coverage altogether. For city and town governments in the Commonwealth, health spending for public workers’ benefits rose 85% between 2001 and 2006, eating up most new tax revenues. And state government spending for Medicaid and other state health programs continues to skyrocket.
With unemployment low and tax revenues high, the state – as well as cities and towns – can scrape by and meet their healthcare obligations. But when the economy turns sour, tax revenues will drop and business will lay off workers and cut benefits for those who remain. The number of people needing free or subsidized coverage under Chapter 58 will balloon, just when the Commonwealth’s coffers are empty. Predictably, the subsidies and coverage will be slashed. Meanwhile, the costs of unsubsidized coverage will continue to rise, leaving fewer and fewer able to afford even the meager offerings under the Commonwealth Choice program.
Unfortunately, the cost control provisions included in Chapter 58 are laughable. No serious observer thinks the toothless “Quality and Cost Control Council” will be able to rein in costs. The computerized health records touted in the bill may improve quality – even that has yet to be proven – but there’s not an iota of evidence that they will save money. And while improved quality and increased prevention – the other pillars of cost containment in the law – are great ideas, they generally raise costs, not lower them. Americans currently receive only about 55% of recommended care, so improved quality frequently means more, not less care. Prevention often keeps people alive (and needing expensive medical care) for years, rather than allowing them to die a quick and cheap death. Indeed, when Louise Russell analyzed the cost implications of prevention some years ago, she could find few things beside immunizations that are likely to save money.
That’s the bad news.
The good news is that there is enormous fat in the current health care system that could be trimmed. By moving to a simple, single payer system we could save about half of the $5 billion we’ll spend on hospital bureaucracy in Massachusetts this year. $2 billion or more could be saved by simplifying doctors’ paperwork, eliminating the need for a huge office staff to do billing, costly billing software etc. And more than a billion could be saved on insurance overhead if we replaced our wasteful private insurance firms with a single public plan.
Additional savings could be realized by having a single payer for prescription drugs, which could bargain with drug companies and bring prices down to the levels that Canadians pay. And limiting the profusion of expensive – and often useless and even harmful – high tech care could save billions more. Doctors and hospitals may make a bundle by offering whole body CT scans to the worried well, but patients get mainly unnecessary radiation.
In sum, single payer reform could save enough to make health care affordable – for everyone. Without such reform, we’ll soon again see a rising tide of the uninsured.
David Himmelstein is an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program
Massachusetts like other regions of the world is being faced with increased pressures to cover costs, particularly of health prevention. What is very worrying is that Massachusetts treasurer Cahill reports that casinos and slot machine gambling would alleviate this pressure on the health system, by adding to tax revenues.
Please be warned by Australians who have suffered slot machines for 15 years, in all but one state of Australia, that this is NOT a plan that will help to pay for increased health costs. Our ONE state, Western Australia, that refused to have pokies or slot machines is now the only state that is surviving financially and growing in infrastucture terms. Slots have drained the coffers of all other states, so that bankruptcies, divorces, mental illness, suicides, theft and other crime rates have all soared! Businesses are failing while billions of dollars goes out the country’s door to the gaming industry. The government share is just too inadequate to cover the added social costs. Our government gets 30% of the gambling take….and now we say it should be at least 50%. SOme people propose that the government must OWN the machines itself 100%…so that the government can then take full ownership of the rising costs.
How much will the Massachusetts government get of the casino take if these are allowed, with slot machines, to invade your state???
The majority of people surveyed across Australia by local governments in 2005 all called for slots to be banned or made much safer, with player smart cards to be offered, to limit and record spending.
Slot machines are dangerous products, purposely designed to addict using subliminal messaging, contrived ‘near miss’ wins and hypnotic features to addict normal human beings. These deadly machines that attack normal people to cause over-spending are presented as ‘harmless toys’, but are in fact dangerous consumerequipment, with insufficient protective features to prevent predicted and planned addiction.
If slots were the universal financial ‘cure’ that we were led to believe that they would be…why then do most people in Australia now want them gone?? Look also to New Zealand, Guam, as well as to Canada and South Carolina…and Norway…how much evidence do you need?
You are all being conned…made to believe that you can score from another’s inability to restrain himself…you are being conned to suggest that slots will make you a profit over years!
Do all that you can to keep your businesses productive…do not follow our path….check out why people hate these insidious machines of destruction….we are NOT wowsers who want to kill good fun….we are normal business people and community workers who have SEEN the huge losses that have been caused…while the gaming industry gains….along with the puppet governments it entices, then cripples. Slots cause FAR more in health cost terms than they GAIN. And ALL people pay those costs….this is not a case of ‘getting something for nothing’ here…where we might as well get money from stupid slots players…because THEY are costing us ALL far too much. We all pick up their pieces!
You have NOT been told the truth if you believe that slots / casinos etc are an “INEVITABILITY” that will bring “MORE MONEY” to communities. They in fact suck them dry. THINK AGAIN!! Check the internet…see what objections are occurring in other countries, who are crunching under slot machine addiction!! Your government is clutching at a straw….and the straw is poisoned!!
Only the gaming industry giants will not draw the ’short straw’ if you bring in this form of revenue -raising!
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The reality for healthcare like everything elswe is that price of services is rising faster than general inflation and personal income is not. Price controls on drugs, and caps on fees is not an answer. Even if we could eliminate all private insurers in favor of a single payer system that worked as envsion with virtually no frictional expense prices would still rise because medical innovation and drug development expenses require enormous capital investment well beyond inflation. Couple those expenses with our litigation society we then come to a place where the practice of medicine is intended to thwart price inflation. It simply cannot happen and expect healthcare delivery to be maintained at the standards we have come to expect.
Access to medical is while vexing is not a mystery. We could as a society reduce spending on innovation and delivery care that eventually will make our new universal healthcare system unusable. We could cut the salaries of professionals to the point where those who require student loans will be unable to pay them back. We could outlaw health insurers and if that is not possible health insurer profits. How that would work is anyone’s guess. The fact is that universal healthcare that is affordable is not one formula. It is not the Canadian System, National Health in Britain or even the vaunted systems in Signapore and Taiwan.
We must recognize first that we want forms of Universal Health Care. Not everyone will have the same plan. Everyone will have basic medical services but for those services that are not captured by any of the medical payments schemes we have to set to study how to tackle their broad use.
Universal health care can be a reality if we first stop trying to fight the big insurers and government. We need to take healthcare back from uncaring administrators back into the community. From that foundation we can then search for solutions to medical inlflation.
Hi,
Just found your blog on Technorati & Digg upcomming news feeds and read a few of your other posts.
ISeems good contents,Keep up the good work. Look forward to reading more from you in the future.
Thanks,
Michael