If Massachusetts is serious about controlling rising health care costs, we’ve got to start acting that way. So far, we’re not. Some thoughts on our current predicament:
1. MA health reform critics complain Chapter 58 doesn’t control costs. They’re right. There was broad agreement on a path to expand access, not on a path to control costs. Some suggest we should not expand access until we agree on how to control costs. We only hear that complaint from folks with insurance. We disagree that the uninsured (155,000+ covered now) should have to wait for that consensus before we expand coverage.
2. Some talk about the cost crisis as though it only relates to health reform. Not so. Rising costs affect every element of society – not just those helped by health reform. David Williams at the Health Business Blog reports his business’ health premiums will rise 26.3% next year. Whether it’s a state, municipal, business, or family budget, the cost crisis affects you. Health reform is an asterisk in the bigger health cost picture.
3. One part of Chapter 58 seeks to address rising costs – the Quality and Cost Council, a 13 member body formed “to establish health care quality improvement and cost containment goals.” On June 20, the council approved its first set of annual quality and cost goals. Health Care for All published them on our blog. To our knowledge, these goals have received virtually no public discussion or comment.
The Q&C Council is composed of dedicated, smart individuals committed to using the Council as effectively as possible. Still, we worry the Patrick Administration and legislative leaders think they’ve done their job by “tasking” the cost challenge to a Council with no real power, limited resources, and sparse visibility. We fear the challenge of confronting rising costs is beyond the Council’s capacity to handle on its own. They can play an important role. But a challenge this size – how about a brass knuckle Cost Control Summit hosted by the Governor, Senate Pres, and House Speaker? That’ll get noticed.
4. Check out, if you will, the Council’s year one goals. The first one deals with costs and it’s a doozy: “Reduce the annual rise in health care costs to no more than the unadjusted growth in Gross Domestic Product (GDP) by 2012.” The rest apply to quality – such as reducing hospital acquired infections etc. The set of goals embraces a popular hypothesis in health policy – that if we just get quality right, given the documented amount of clinical waste in our system, that’s the magic pill to cure our cost disease. Wouldn’t it be luverly?
What if this hypothesis is wrong? What if we do everything quality-wise and costs still rise at destructive, unsustainable rates? Are we willing to consider “R” word – regulation? We deregulated our cost-control system in 1991 believing that market forces and competition would do a better job. It did for about five years, and now we’ve had close to a decade of budget-busting premium hikes. Are we ready to acknowledge the failure of the 1991 deregulation strategy? Do we have to wait until 2012 to see if the new strategy will work? We don’t think we can afford to wait til then.
5. Massachusetts needs a comprehensive, high-level, coordinated, multi-year cost control strategy. Not for auto insurance, for health insurance.
PS: In March, Health Care For All published 17 ideas we think could be part of this strategy. Click here to view the report. We filed it as legislation that will be heard by the Health Care Financing Committee in October. Also, click here for a new Commonwealth Mag article on rising health costs.
John E McDonough – mcdonough@hcfama.org – is executive director of Health Care For All.
John — Speaking at least for myself, the Q&C Council’s recommendations don’t get any play because I don’t see how they have the teeth, or budget, or time, or energy, or power to do anything other than make a website and “set goals”. Quality and cost are the central battle in the reform, as far as I’m concerned, but I don’t see how the Council is set to contribute.
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We have met the enemy and it is us
The Massachusetts universal coverage plan and the next-stage efforts at health care cost containment get somewhat cynical, yet sobering, coverage at CommonWealth magazine. The article in the current issue is titled Cost Unconscious. MassINC, which publ…
my question is why does the state want to force business and citizens to move out of the state because of this outrageous law? people can’t afford this”affordable insurance”.don’t they know this?I will be forced out and so will others.
Norma,
I agree. This law effectively enslaves us all to the health insurance industry that skims 31 cents off of every dollar spent on health care. This is not a serious effort at reform, since even if we could afford to buy these policies, we could not afford to use them. It is time that we contact our legislators and demand that they do better! We are the last industrialized nation on Earth that does not have some real form of universal access.
Controlling health care costs will be critical going forward. While it is ok to expand access in one phase and then address cost in another, it is critical that one doesn’t expand care at the expense of cost, which I think is a good possibility with the current approach. I talk more about this in my blog article on Mandatory Health Insurance and its disincentives for innovation in medical practice.
In reply to this post and to Vijay:
If we are truly sincere about achieving cost controls then we must get on course to enact the widely embraced reform for an expanded and improved Medicare For All program on the national level (as in HR 676) and provide leadership toward that goal on the state level (as in SB 730 here in MA).
Anything less is mere tinkering that keeps the elements of our broken, wasteful, and harmful system firmly in place and may indeed make things worse, as Vijay points out that the MA Chap 58 law will likely do. I and many others firmly agree.
Canada’s reform that led to the civilized model of guaranteed comprehensive care for all began one province at a time and evolved into a national program.
At present the Canadian Universal Medicare program is underfunded; spending about 1/2 less per person than we spend in the U.S. on HC. But it is a good model that uses streamlined single payer financing to guarantee cost effective access to needed care for everyone.
We Americans are a smart and caring people who, if given the choice, would gladly take the option to modify such clearly preferable models such as Canada’s and France’s to meet our needs and our budgets and enact an improved Medicare For All U.S. health care program.
After all, healthcare should be for people, not for corporate profit and individual fortune, right?
To learn more visit
http://www.DefendHealth.org
and
http://www.MassCare.org/legislation
I think health care costs should rise.
We need real change in our nation’s health care policy. At least the democrats are proposing solutions, while the republicans just offer excuses as to why we shouldn’t nationalize healthcare.
this”affordable insurance”.don’t they know this?I will be forced out and so