Yes, Jon, much about the current health care mess is unfair and has been for a long long time. For small businesses, for families and for individuals. Legislators have really good coverage I believe. That is unsettling to me and many others.

I hope readers of this post will scroll through others on this valuable public forum that WBUR has created to learn about the issues and suggested solutions.

And Jon, with your understanding of out-of-control private health insurance costs that you have now, are you by any chance wishing that you had not been such a vicious spokesman against the Ballot Question 5 back in the year 2000?

At that time in your RAM role you publicly attacked Q5 and used very effective fear-mongering tactics against the initiative that had huge public support until the Insurance Co’s and HMO’s spent $5.4Mil against.

Q5 sought to require insurance companies to spend at least 90% of their revenues on health care services (hence limiting their admin. spending to 10%) and to require the state to bulk purchase prescription drugs to help hold healht care costs down.

Both of these reforms are MAJOR POLICIES FOR COST CONTROL that will help small businesses and main streets across the Commonwealth.

I hope that RAM will support these bills now. YOU can contact Senators Jehlen and Montigney for details.

As a small employer, do you believe RAM should be in the insurance coverage business? Have you thought about dropping coverage?

to the Rev.- RAM is a lobbying group that, from the above info, exists to represent the interests of 3000 retail businesses in the state. With this info in mind, your questions posed here to RAM are confusing. Could you please clarify what you mean. Thanks.

Jon says that RAM, as a small employer (and I’ll take him at his word on the size of his lobbying group), was out another 22% in insurance costs recently.

I’m asking if his organization might not benefit better as a viable concern by turning the spigot off–at least the one he and his group has control over. His 3000 members may follow.

Thanks for the comments Ann. But no, we aren’t prepared to abandon the competitive marketplace and free choice. Quite the opposite actually. We firmly believe that the reason the market works for some but not for others is because of restrictions placed upon the small group market that simply don’t exist either for big business or big government. More than a decade ago, the law was repealed which allowed small employers to group together to seek discounts from the insurers. We believe it is no coincidence that small group rates have gone up by double digits nearly every year since, and we have less insurers in the state. Group buying and negotiations is a basic economic principle for seeking more insurer competition and fair rates compared with the big guy across the street. What is good for the GIC, for cities and towns, and for big business ought to be good for small businesses and small non-profits. So Ann, let’s work to make the marketplace truly competitive, broader, fair and open to all. It works in retailing and virtually every other industry. Why not remove the restrictive barriers designed to benefit only select groups and let it work for everyone seeking health care?

And no Rev. Communete; we certainly aren’t looking to drop coverage, but it’s certainly getting harder and harder every year to afford the same level of benefits for employees that we granted the prior year.

Our top priorities going forward are simple: 1. Lower health care costs for everyone; and 2. Allow for fair and comparable insurance premiums throughout the marketplace.

“Free choice” is only an illusion for most people when it comes to health insurance. It does a grave disservice to perpetuate this myth. It is why we have 47 Million uninsured in America including half a million STILL uninsured here in MA.

Policies that force the cockamamy notion upon us that a “competative marketplace” can ever exist in healthcare coverage also do a disservice because as we have seen for years and years, these “marketplace free choice” policies are DIRECTLY RESPONSIBLE for much preventable harm as well as for wasting a HUGE amount of money.

If you cannot see these things as facts then would you please explain to me why not?

Healthcare has never been and will never be a commodity. It is a human need. People can live without a toaster or without a car, but not without healthcare.

In MA, uninsurance is the 3rd leading cause of death for people between the ages of 56-64 yo. (see Inst. of Medicine report “Consequences of Uninsurance” state data section.)

It ashames me that the U.S. is the only industrialized country in the world that lacks a system of national health insurance. In MA we had a chance to lead the way toward this but instead are moving backwards by treating it as a commodity in an artificial and wasteful “marketplace” model. This instead of crafting policies that treat health insurance and care as both an individual and a social good. We must change this misguided reform into something better for health and better for the financial stewardship of everyone’s healthcare dollars–taxpayers, employers, all of us.

There is more than one policy approach that could satisfy the goal of providing guaranteed coverage for comprehensive, affordable quality care for all.

Why is RAM not able to support this work? Why can’t RAM support the major cost control steps of requiring health insurers to spend 90% on healthcare? Or for the state to bulk purchase more affordable prescription drugs that will benefit state residents including members of RAM and their families?

If RAM does not support these steps than how does RAM propose to work toward your stated two priorites?

Thank you in advance for your response.

I think we would all be remiss to not work together to try to make this important experiment succeed. That doesn’t mean there aren’t adjustments that can’t or should not be made. More transparency on actual cost and quality and how it applies equally or even unequally to all consumers–from big government and big business, right down to small employers and individuals–needs to start with the insurers, the hospitals, doctors and all providers. This is absolutely vital to take the next step on competition. Without that transparency, individual consumers and small employers are disadvantaged and lack the tools to help themselves, or to even show whether they are being dealt a fair hand in the marketplace. Once that information is clear to all, then we can have an intelligent debate whether competition can begin to work better for us all. And if not, whether we need to go in the other direction towards rate regulation.

Having been in a bit of a rush earlier and seeing no response from RAM/Jon yet, I’ll take his above words as at least a partial answer:

“Group buying and negotiations is a basic economic principle for seeking more insurer competition and fair rates compared with the big guy across the street. What is good for the GIC, for cities and towns, and for big business ought to be good for small businesses and small non-profits”

Jon, if your above logic holds up, and you can accept as a worthy goal the crafting of reforms for everyone to have the security of affordable quality coverage, than why not have the largest bargaining pool possible created–the entire population of the state?

Then the price negotiations could take place directly with the service providers of healthcare. We could get away from the current wasteful practice of using the insurance co. middle-men who waste about 30% of every healthcare dollar on non-healthcare expenditures.

We have publicly funded health departments that do a good job with assuring us safe water and food services, infectious disease monitoring, terrorism preparedness, and so on.

Why not have our insurance monies collected publicly and then budgeted out for the PRIVATE DELIVERY of services?

With this streamlined financing approach for truly universal coverage, doctors, nurses, etc would NOT be government employees but would remain in private practice, or employed by Partners, BIDMC, Baystate Medical, community health center employees, etc, but would have to meet quality standards and cost effectiveness measures that would be universal for all settings across the state and publicly accountable.

People would have full choice of what doctor and facility they wanted for care. They could choose based on quality and convenience, not forced into limited options by employer coverage “choices” or having to opt for the chaepest plan to still have money for food and rent/mortgage.

Plus, continuity of care would not be interupted as it often is now under our fragmented private market-employer coverage system.

What’s the downside you see in something like this approach?

I can understand your focus on your RAM members interests as the CEO of that lobbying group, but isn’t what you propose as a partial solution– re-enacting the law allowing small businesses to group together and negotiate much as the state’s GIC does–in effect, just another form of tinkering around the edges of health system reform that ignores other sturctural problems and leaves many people shut out of needed coverage?

I think these concerns are a reasonable conclusion and know that many others share this view. While a restored “Small Group GIC” might do some good–especially for your members– it would sadly leave in place most of the underlying causes of our growing crisis in healthcare access, cost, and quality.

We must do better than this and together, we can.

hey, I guess we were posting at the same time; most of my 2nd comment still stands. Many people are seriously hurt EVERY DAY by being uninsured; this brings a real urgency to our work.

I agree (again) with Working Nurse who may have previously confused health INSURANCE coverage with health CARE for all, but has now clarified the matter as it should be: providing health CARE is the top priority and where our money should go. Insurance is an enormous waste of energy and money.

But aside from that, for those of us who are mostly healthy and have chosen an HSA with catastrophic insurance coverage, whenever we do need to get health care, from a well check up to an MRI, we are offered ‘list prices’ for the services. These are certainly NOT the prices paid by insurance companies or Medicare, but what individuals are charged simply because we have little alternative. I have not seen this matter addressed by the legislation or in any forum yet. Why is that?

And another thing: as an owner of a small business, I have had to go through a middle agent to get health insurance for my fewer than 5 employees opting to be covered. But I got a quote from a company with the same census before one of the employees dropped out (for cost reasons). The difference in the monthly premium was over $60 per individual employee, or about $3,000 per year that I now pay EXTRA, just for not meeting the minimum number of employees the underwriter requires to deal directly with the company. So now I pay more and must deal with an agent, not directly with the insurer, and there is no advantage in that. The $3,000 annually may not seem like much to a larger company, but it is quite something to a small company. Strange set up, to be sure.

Jon, your constituents’ golden goose has been taken by Health Care, Inc.

Are you sure you guys completely thought this out before signing onto 58? If everyone’s $500.00 is siphoned off each month into the mirrored-glass-clad black holes of Partners et al–as planned–then who do you think is gonna put money on credit cards to go to dinner at Bickford’s and buy records at Strawberries?

Your state economy’s largest industry would appear to be giant vacuum cleaners, that want to suck dollars from even the most reclusive pockets of their surroundings.

Rachael, I appreciate your situation and hope you will copy and paste your story into the Governor’s new healthcare reform section website at http://devalpatrick.com/issue.php?issue_id=7577398

Gov. Patrick and his Cabinet staff are on a steep learning curve and need to gain more understanding form the REAL LIFE experiences such as yours about healthcare policy. Your story reveals the absurdity of the new “Insurance Connector” contraption that is spending millions on marketing private plans including a “Sub-Connector” contract with a firm to provide broker services for the “new affordable” insurance products that will be brought to us/shoved down our throats as part of the Chapter 58 reform plan.

I kid you not.

Please go to the GOv’s webiste health reform section at http://devalpatrick.com/issue.php?issue_id=7577398 and “vote” for this issue to get the Governor’s priority attention. Thank you.