So, the anniversary of the first year of health reform, as we perceive it, has come and gone, and going into year two we have significantly increased the number of “insured” residents in the Commonwealth. We should and do take great pride and praise for being the first state in the nation to make a commitment to “health care for all” of its residents. Through expansion in entitlement to MassHealth and the “safety net plans” for classes of people too poor to afford market health insurance through Commonwealth Care and the affordable options of Commonwealth Choice we have moved ahead in increasing coverage. However we have done nothing, that even misconstrued, can be considered by any rational person to be health reform. So let’s call it what it is! Or is it what its not?
It is expansion of health insurance in its various iterations, employer based, individual and group, and government sponsored, to uninsured residents of Massachusetts. It is not health reform, and that’s the problem. It is increasing dollars spent on a broken system. It is not changing the system. It is giving people access to care. It is not improving care. It is investing more money with no return on that investment in terms of decreased cost, improved quality or increased accountability.
In a recent television interview, candidate for President, Hilary Clinton was being pressed by the reporter on whether she would call for an increase in taxes in order to institute the kind of reforms she envisioned in health care. She said no. He pushed her with candidate Edwards position that any candidate unwilling to admit that taxes would have to be increased for us to accomplish health reform, which to Edwards, like Massachusetts politicians think means universal coverage, was not being honest with the voters. Senator Clinton’s response, as someone who had occasion to study real health reform, was that she would refuse to invest any more dollars in what is obviously a broken system. Exactly the opposite of what we have done in Massachusetts. We’re pumping more money into a system that’s becoming increasingly more expensive, with decreasing quality, and will not improve the health of the citizens on Massachusetts. The only winners in Massachusetts health reform are the insurance companies and health plans.
Who would dare to speak against universal coverage? However, how many of us wonder at what cost? For example, how much money is being spent on advertising, marketing, outreach, enrollment, and all the “administrative” costs associated with the creation of the “quasi” governmental Connector as yet another layer of administration, and the implementation of only the affordable access aspect of Chapter 58? Could this money be better utilized to decrease the costs of health care and support real reform through a single payer system?
The group, Physicians for a National Health Program, suggest taking advantage of this moment in time … with a Presidential election on the horizon and the heightened visibility of the American health care system crisis, as a result of Michael Moore’s film, “Sicko”, to organize a national campaign promoting a single payer system. On the national level they have sponsored legislation, HR 676 General Resolution, that calls for creation of a US National Health Insurance system, giving everyone access to affordable quality health care paid by saving $300 billion, according to Harvard researchers, in administrative costs.
The group suggests organizing on the state and local level to have state legislatures and city governments pass resolutions supporting HR 676. They also suggest organizing events to coincide with showing of the movie; scheduling grand rounds at hospitals and health centers; panel discussions in communities; securing Representatives and Senators to co-sponsor single payer legislation; and becoming politically active in the Presidential primaries and challenging the candidates to address real health care system reform.
We in Massachusetts are uniquely positioned to step out in front of this movement, just as we did some forty years ago with the beginning of the community health center movement here in Boston, another movement for health access, equity and justice. To paraphrase a favorite son of Massachusetts … if not us, who … if not now, when.
LINKS:
Sicko: Sickocure.org
National Health Insurance Bill: PNHP.org
HR 676 Resolution Campaign: PNHP.org
Elmer Freeman, Executive Director, Center for Community Health Education Research and Service, Northeastern University; Co-Chair Critical MASS.
Well said Mr. Freeman. We can never reach the goal of universal access through a patchwork system of insurance laws, a coherent federal policy is desparately needed. The Massachusetts law only throws good money after bad.
Ron, Why is a Federal policy needed? Seems that health care is a very local issue and that waiting for Federal action is going to be a long wait and they might get it just as wrong as Massachusetts has. Better to keep health reform a local issue not subject to the tendencies of Federal corruption.
The political problem as I see it is that much of this issue is wrapped up in the goal to provide everyone the same level of top care that the rich get with the most expensive health insurance packages today, packages which are themselves subsidized by the meager and unusable insurance chosen by the lower middle incomes and young. But a top down approach is not the way to approach a public policy issue.
Any other public safety issue would not be approached the way Massachusetts has approached health care. We would not set a flat fee for any other public services which would put a greater and more onerous burden on people of middle incomes. Every tax we have is based on some idea of fairness that people of greater wealth and income should pay a similar share of their wealth and income as do those of lesser means. The sales tax and income tax are clearly designed to do this and to a lesser degree the theory behind property taxes is that they should be a reflection of wealth and a persons ability to pay their “fair share”. Though in practice it has become more of a head tax. “Fair share” of course means different things to different people, with some people believing that a fair share means that the rich pay a greater portion of their wealth and income than those of lesser means, I don’t share that view, but at the very least the principle of tax fairness requires that people of greater wealth and income pay an equal and not lesser portion as those of lesser means.
The idea should be how do we provide a minimum level of basic care to meet public health and safety needs, not how to provide Lexus Care for all. The solution should involve a fair tax and not a wave of the hand mandate.
I’ve written before that a 1-3% flat income tax would be a more fair way to pay for this public policy and I believe that the $5 billion that this would generate would provide more than enough tax revenue to support basic emergency services for all, basic preventative health care and vaccines for children and adults with perhaps enough for some level of care for the more easily treatable chronic illnesses. The more expensive diseases to treat would simply have to be left out of what was covered. Call it rationing, call it whatever you want, but that is the only fair way to run a health care system to meet the needs of common good.
Health insurance doesn’t go away, it just becomes supplemental. Charity doesn’t go away either, because there will always be gaps that need filling. But the result is a much healthier society than you have today at a much lower cost than is currently spent on health insurance.
But the point is that it is very doable at the State level, but there is a serious lack of political will and the insurance lobby is far too powerful. We have given them far too much of our money to play with and they don’t want to give it back.
But these problems are only worse in Congress. Any plan that they come up with is going to be even worse than what Massachusetts has already come up with. They see compromise in terms of how many corporations get a cut of the publics’ money, same as in Massachusetts, but at the Federal level there are more political mouths to feed.
http://groups.google.com/group/fair-health
Pat,
The reason I feel a national policy is needed is because it provides the numbers to make the system workable. I know that you don’t agree, but I really feel like a single payer system is the only thing that makes sense. And, it does not have to be Lexus health care. It would provide for preventative and interventional care for all, but need not cover such frills as cosmetic procedures. The rich could still purchase their botox injections and tummy tucks out of pocket. I just think that access to doctors and hospitals are basic human rights and the only way I see to provide them is a nationalized health care system funded by a fair and equitable tax. Is this a panacea? Of course not! But it has to be better than what we have now.
Ron, have you taken a look at the Massachusetts numbers? I never said I didn’t agree with single payer, but I think what you propose would be workable in Massachusetts to go it alone. Massachusetts Single Payer. Really how would you expect single payer to work on the national level if it couldn’t work at the state level in one of the richest and healthiest states in the country. But I think to make this feasible you need to start out by leaving out even some expensive life saving procedures in order to keep it economical. I don’t have a list in front of me, but you simply can’t keep everyone alive forever at any expense, it is simply not doable. Cost control and limiting the cost of procedures is the only way you can keep control of a single payer system. The insurance companies do this now anyway. Single payer in Massachusetts, even if it is much more restricted than you envision, to me is much better than the system we have now (even with the minimum insurance mandate) which just leaves people without accessible health care.
Pat,
Fair enough, let’s start at the state leve1, if we’re going to be the laboratory, let’s make it a meaningful experiment. Granted, under a single payer system some things would have to change. A lot of waste could be immediately trimmed by taking private insurers out of the equation, though. Under managed care, the HMOs work on the “completion backward principal”, where the most oblivious (and unfortunately, often the most expensive) diagnostic tool is used last. For instance, if you have pain in your knee, but no history of trauma, MRI is the definitive tool for diagnosis. However, before you can get one, you’ll need to have plain x-rays. These will likely be negative, since 90% of the time the problem is in the soft tissues. If you persist in complaining, you’ll be subjected to an invasive procedure known as arthrography. This may or may not be diagnostic. Finally, if you try hard enough, you’ll be granted an MRI referral. The whole idea is that the insurance company will place road blocks all along the way, hoping you’ll just give up! The only things that worry me about the single payer model at the state level are the facts that we have an aging population and a problem with young people fleeing the state. (Let’s see: high housing costs, crumbling infrastructure and now a “personal mandate”; who can blame them?) At any rate, we agree that prserving the status quo is counterproductive.
Ron and Pat – thanks for having this important conversation in public. On the subject of universal coverage healthcare reform using responsible financing (often called “single payer”), I want to share the following info with you and others:
This Wed. July 18, at 1 pm there will be a Public Hearing at the State House on The Massachusetts Health Care Trust bill, Senate bill 703. This legislation has been filed every year for 10 years and seeks to create what Ron and Pat are discussing in their above comments!
The hearing on Senate Bill 703 will be convened by the legislature’s Joint Committee on Healthcare Financing. The Senate Chair is Dick Moore and the House Chair is Patricia Walrath (who infamously told a group of 6 health professionals “no health care bill gets through the legislative process in this state without the insurance industry’s approval”. I can give you the names of the 6 of us who were in the room when she said it!! It was in Rep. Walrath’s office, to be precise.)
The hearing on Wed. July 18 is an important time for members of the public who can take time off from work or otherwise arrange to be at the State House – including health professionals, patients, all of us – and show that we understand that the current Chapter 58 “individual mandate” law is largely fake reform and the we demand real reform.
We must send the message – in person, in emails and in telephone calls to Governor Patrick and to our own legislators (State house Switchboard 617-722-2000) that we will continue to demand real reform that benefits ALL OF US until it actually happens. Our economy is suffering greatly from the fake reform that has been foisted upon us.
Please contact Ben Day, Executive Director of MassCare and visit their website for specifics on the SB 703 legislation and/or to testify. Thank you.
http://www.MassCare.org/legislation
P.S. Heartfelt thanks to Mr. Freeman for providing excellent info and links for national reform activities. I agree that now is the time for the good people of Massachusetts to step up and carry this issue forward.
Ann E Malone, RN, MSN posted:
Comment posted July 15th, 2007 at 8:49 pm
“The hearing on Senate Bill 703 will be convened by the legislature’s Joint Committee on Healthcare Financing. The Senate Chair is Dick Moore and the House Chair is Patricia Walrath (who infamously told a group of 6 health professionals “no health care bill gets through the legislative process in this state without the insurance industry’s approval”. I can give you the names of the 6 of us who were in the room when she said it!! It was in Rep. Walrath’s office, to be precise.)”
Oops! I don’t think she was supposed to say that.
Dave – Isn’t it incredible? What is equally incredible is that most people, when they learn of what Representative Walrath said, say “Well, that’s no surprise; she’s just being honest” — And to that I say: “Is this what we have come to?!!!”
Then it’s no wonder things are as bad as they are on so many fronts (ie Bush, Iraq, etc). It’s time to take our country back, including our healthcare system. Together, we can.
There is a lot of wonderful community outreach and education going on across the state to foster an informed and engaged citizenry on this vital healthcare issue (vital for personal health and for our collective economic health!!).
Dave – and others, too, please email me at ann@defendhealth.org so that I can get in touch with you directly. Thanks.
[...] Lindsey Tucker, Health Reform Coalition Coordinator at Health Care for All about Chapter 58, often mistakenly referred to as “Massachusetts health reform” and the availability of affordable health insurance for them as one of the key target [...]