Comments on: AMONG MASSACHUSETTS HOSPITALS: THE RICH GET RICHER by David Himmelstein, MD http://commonhealth.wbur.org/david-himmelstein/2007/12/among-massachusetts-hospitals-the-rich-get-richer-by-david-himmelstein-md/ CommonHealth Fri, 19 Mar 2010 17:52:41 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: E Raymond http://commonhealth.wbur.org/david-himmelstein/2007/12/among-massachusetts-hospitals-the-rich-get-richer-by-david-himmelstein-md/comment-page-1/#comment-5388 E Raymond Fri, 07 Dec 2007 16:46:44 +0000 http://www.wbur.org/weblogs/commonhealth/?p=292#comment-5388 I am surprised to see you cite 2007 figures as an outcome of health care reform. I don't think any economic effect of the law is felt right now - its just to soon. I'm also a little confused about the 'detailed mechanism' you name. As I understand, the free care pool used to compensate some hospitals (cambridge health alliance, bmc) for providing free care at 90%, some at 85%, and the remaining hospitals got whatever was left over. Now, the free care pool has shrunk as the uninsured get insurance. It may be that places like CHA and BMC are finding that insurers do not compensate at 90% of costs, as the free care pool once did. And I'd expect that hospitals that got very low compensation from the free care pool may find insurers pay for care at a higher rate. But isn't this a more stable system, which in the end should provide more consistent care to the previously uninsured? And why do you feel that paying hospitals for care using an insurance mechanism rather than a free care pool, proves that Partners and Blue Cross are gaming the system? Seems to me that this is the very public, obvious point of the entire law - not some hidden back room deal made by lobbyists and corrupt pols. You say: "While the detailed mechanisms of the shift are best left for another time, the results are striking." Its not clear to me that the striking results you name have anything to do with health care reform. I'd be very interested to hear more on what you have to say about the detailed mechanisms of the shift. - E Raymond I am surprised to see you cite 2007 figures as an outcome of health care reform. I don’t think any economic effect of the law is felt right now – its just to soon.

I’m also a little confused about the ‘detailed mechanism’ you name. As I understand, the free care pool used to compensate some hospitals (cambridge health alliance, bmc) for providing free care at 90%, some at 85%, and the remaining hospitals got whatever was left over.

Now, the free care pool has shrunk as the uninsured get insurance. It may be that places like CHA and BMC are finding that insurers do not compensate at 90% of costs, as the free care pool once did. And I’d expect that hospitals that got very low compensation from the free care pool may find insurers pay for care at a higher rate.

But isn’t this a more stable system, which in the end should provide more consistent care to the previously uninsured? And why do you feel that paying hospitals for care using an insurance mechanism rather than a free care pool, proves that Partners and Blue Cross are gaming the system? Seems to me that this is the very public, obvious point of the entire law – not some hidden back room deal made by lobbyists and corrupt pols.

You say: “While the detailed mechanisms of the shift are best left for another time, the results are striking.” Its not clear to me that the striking results you name have anything to do with health care reform. I’d be very interested to hear more on what you have to say about the detailed mechanisms of the shift.

- E Raymond

]]> By: Norma http://commonhealth.wbur.org/david-himmelstein/2007/12/among-massachusetts-hospitals-the-rich-get-richer-by-david-himmelstein-md/comment-page-1/#comment-5386 Norma Fri, 07 Dec 2007 11:01:05 +0000 http://www.wbur.org/weblogs/commonhealth/?p=292#comment-5386 Doctor David Himmelstein, I am one of many in this State who does not understand the lawmakers idea that this mandate is a good idea.The office of my Senator told me "the State does not want residents using the emergency room without insurance." The dollar is more important than human beings? I do not have insurance and cannot afford it.What do I do if I get a medical emergency? The emergency room services are too exspensive.The medical insurance is too exspensive.As a medical doctor can you tell me,do I just lay down and die because I am not poor enough or wealthy enough?Can someone answer this question? Doctor David Himmelstein,
I am one of many in this State who does not understand the lawmakers idea that this mandate is a good idea.The office of my Senator told me “the State does not want residents using the emergency room without insurance.” The dollar is more important than human beings? I do not have insurance and cannot afford it.What do I do if I get a medical emergency? The emergency room services are too exspensive.The medical insurance is too exspensive.As a medical doctor can you tell me,do I just lay down and die because I am not poor enough or wealthy enough?Can someone answer this question?

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