When we get our checks from the Fed this summer to spend on consumer goods and services to try to resuscitate the struggling US economy, let’s all spend it on health care! Let’s join together in a collective strategy to suppress health care inflation in the Commonwealth, to ensure the success of the Massachusetts model of health reform. The Connector has already thought of this considering recent proposals that would jack up premiums… and shift more cost to consumers. These are short term budget fixes, not reform.
From my previous entries on this blog, you know I have not been enamored with the promise of reform in Chapter 58. The real opportunities for reform take a backseat to increasing access by expanding coverage and simply pumping more dollars into a system that is almost irreparably broken.
Yesterday I attended presentations by graduate students at Northeastern University who were among some 40-50 students who attended a two day seminar sponsored by the Massachusetts Health Policy Forum for graduate students from many local area universities studying medicine, nursing, public health, public administration and other disciplines. The student forum was held in January and included two full days of talking with policymakers, legislators, administration officials, practitioners, etc. all focused on Massachusetts’ great health care experiment, Chapter 58. The students consider it a success only if measured by the singular objective of increasing the numbers of Massachusetts residents with health insurance of some sort. However, it did not take long for them to realize the absolute impossibility of sustaining increased coverage in light of rising costs for everything from food, to gas, to prescription drugs and health care. They were all looking for the answer … how do you keep it affordable, when the price keeps going up?
Everyone knows we have to do something about spiraling health care costs or our experiment will fail. One of the key elements of Chapter 58 that could help, the Health Care Quality and Cost Council, remains dormant. The questions here are do we have the political will to “mandate” price controls and other reform strategies as we have done with coverage? And are we willing to penalize those that do not comply? Clinging to a market based ideology in health care makes no sense especially when market principles, such as the relationship between cost and quality, have no influence whatsoever on consumer decisions in the market of health care goods and services. Do we take lessons from the US automobile industry that didn’t realize that “quality is job one” until it was almost too late.
To meet the promise of universal coverage, we have to keep it affordable for it to be a success and everybody has to ROW HARDER. Under Chapter 58 we have witnessed a corporate take over of our health care system … and we need to take it back.
Elmer Freeman, Executive Director, Center for Community Health Education Research and Service, Northeastern University.
Well, let’s see — I work as a primary care physician. I’m rowing as fast as I can. I spend 50% of the 60-80 hours I work every week doing paperwork to try to get patients the medical care they need. I gross a less-than-six-figure income. I pay $2000 a month in student loans. I have no savings, no assets except personal possessions and a car, no retirement plan or 401K. I don’t think I can row any harder
I care for patients who struggle to pay the copays and deductibles for the medications they need for chronic diseases such as hypertension and diabetes. Some spend $400+ a month on medications even with their prescription drug coverage. Many of my patients who have Medicare decide every autumn whether they will buy their medications for the rest of the calendar year or buy groceries or heat their homes. I have a number of patients who have put off necessary health care because of high deductibles and co-pays. Some have suffered serious or life-threatening consequences as a result. I don’t think they can row any harder.
As I see it, a small number of executives in the insurance industry are pocketing large gains, as it seems that BCBS, HPHC, etc, remain quite profitable despite substantial increases in the cost of health care leading to substantial increases in the cost of health insurance. And most of the employees of these companies are not taking home all that generous salary or wages, while daily dealing with angry providers and consumers. A very small number of “suits” seem like the folks who need to row harder.
The underlying issue, however, is very real. As a culture, we have to ask ourselves how much health care are we willing to pay for, and what limitations are we willing to tolerate? If we do not set limits (and yes, I mean rationing in some form)underlying real health care costs will continue to climb rapidly, perhaps exponentially. “Rowing harder” doesn’t solve this problem. Only a true national dialogue on how much is enough health care for everyone will solve this problem. I don’t see the national willpower to hold that dialogue though. Politicians, whether liberal or conservative, would rather promise us easy solutions, either taxation based or market based, rather than leading us in a real discussion of limits.
Hi Betsy – don’t stop there. Where would you begin the conversation about “how much health care is enough?” Is there an easy (easier) place to start?
Martha Bebinger
As someone who works in a community helath center, while paying for school, life’s expense’s, and is trying to keep head above water, I applaud Betsy’s response. How and where do we begin to stike a balance in a system that has roots firmly planted in soils of profit rather than providing care?
I am a bit perplexed by the lack of discussion regarding increased numbers of those enrolled in care in relation to the wait time to receive care. More and more people are registering for care, but if access to care was a measurement of success in health care reform, I wonder where we stand. On one hand I see numerous people seeking care and having to wait months to see the physian thus utilizing the hospital for care or having the wait time exacerbate the illness. On the other hand, I see people who are unable to see their private physian because they are unable to pay the additional copayment ascribed to their private insurance.
Perhaps discussion on these topics exists and someone could point the way.
Rebecca
Hi Rebecca – where are people waiting months to see a physician? Would you mind providing a few more details? Are these people waiting to see primary care docs or specialists?
If you’re rather e-mail me…marthab@bu.edu
Thanks, thanks, Martha Bebinger
Betsey, Rebecca and Martha – People are also unable to find a doctor who will take Commonwealth Care members, nevermind waiting. A young woman I know had to call 7 doctors before she could find one who would see her and this doctor was an hour’s drive – one way. It’s hard to feel good about seeing a doctor you never heard of and you can’t get a reference because none of your friends knows anything about that doctor either.
So as a Commonwealth Care member, she now has to take a day off from work when she needs to see the doctor which she can’t afford to do because she is low income and needs every cent she can earn just to make ends meet – maybe. She can’t really afford the premium, nevermind the copays, and the 2 hours round trip uses a lot of precious gas.
The Connector has proposed a 14.3 percent premium increase and doubling several of the copays. Whether they raise her costs and copays the proposed amount or less, she knows she is probably going to have to drop the insurance and pay penalties because heat, gas, food and property taxes are skyrocketing. Therefore, the investment she has already struggled to pay each month will have been wasted.
By the way, Elmer Freeman, when we get our checks from the Feds this summer to spend on consumer goods and services to try to resuscitate the struggling US economy, we are not going to spend that money supporting this ugly law or paying Kingsdale’s six-figure salary. We will probably either pay off part of the heating bill or do something enjoyable that we couldn’t afford to do prior to receiving the check.
Furthermore, how dare you call this a success when at least 300,000 residents are currently paying penalties to subsidize those who get the insurance for free while the penalty-payers now can’t pay their bills and still have no health insurance?