Radio Boston performed a courageous civic service yesterday: It ventured into the numerical weeds of health reform — discussing the new Massachusetts public opinion poll that Martha Bebinger covered here on CommonHealth — and it actually turned a discussion of health policy into interesting radio.
The segment included pollster and Harvard professor Bob Blendon; Joshua Archambault, director of health care policy at the Pioneer Institute; and Brian Rosman, director of research at Health Care For All. It’s a meaty debate that carefully avoids descending into what Brian calls “Wonkland,” and worth a listen. Already, it prompted this striking comment to host Meghna Chakrabarti from “KatyinQuincy” on Radio Boston’s Webpage:
Speak it, Meghna!
We have an HSA insurance account, and see the cost of health care in print- we need to pay most of it out of pocket.
$465 for a 5 minut office visit to reduce my daughter’s arm…
$375 for an infected fingernail…
$1075 for an ER visit that the doc said “she would make if SHE were my child’s mother.” (My baby had a COLD.
I don’t think the DOCS know how much these routine procedures cost.
Oh, and it’s not possible to negotiate a cash cost.
HELP! The people of Massachusetts are drowning in routine health care costs.
(I just have become a much better provider at home. We rarely see the doctor anymore).
The segment also included a call-in from a Newburyport man who was recently in a bike accident, and was so shocked and appalled by the cost of his ambulance and emergency room care — both the total cost and his out-of-pocket costs — that next time, he vowed, he would say “Screw the ambulance” and the health care system altogether. “I’ll recover” on my own.
Sounds like just about anybody who’s anybody in Massachusetts health care has signed a letter delivered to lawmakers today urging that health care reform include a strong element of prevention. This just in from the Massachusetts Public Health Association:
This morning, a coalition of public health and health care leaders delivered a letter to Massachusetts legislative leaders urging them to include a robust program of community-based prevention, including dedicated funding, in the next phase of health reform. The letter includes nearly 300 signatures, of which 118 are Massachusetts organizations, municipalities, or businesses. The letter and full list of signers can be viewed here or at www.MPHAweb.org.
“We spend most of our health care dollars caring for individuals once they’ve already become sick, and only three percent of our health care dollars on preventing diseases from developing in the first place,” said Valerie Bassett, Executive Director of the Massachusetts Public Health Association. “Today we are saying to the legislature that in order for payment reform to succeed, prevention must be at the center.”
The coalition cited rising medical costs – comprised mostly of preventable conditions – as one reason they organized the campaign. A January, 2011 study published in the American Journal of Public Health found that a mere 5% reduction in the costs of treating diabetes and hypertension could save the Commonwealth nearly $500 million each year.
Amy Whitcomb Slemmer, Executive Director of Health Care For All and a convener of the Campaign for Better Care said, “The opportunity that we have before us today – to enact comprehensive payment reform that emphasizes prevention and wellness, not only disease treatment – may not come again for decades.”
Just an idle question that comes to mind: If there’s this much consensus about the importance and cost-effectiveness of prevention, why do public health budgets keep getting slashed?
Public Health commissioner John Auerbach speaks at the council's 5th anniversary
The Health Care For All event yesterday was mainly to celebrate the first five years of the Consumer Health Quality Council, which aims to help patients and advocates influence health care in Massachusetts.
But there were also a few “forward-looking statements,” as publicly held companies like to put it. Amy Whitcomb Slemmer, head of Health Care For All, said:
This morning is an opportunity to reflect on the last five years, and to look ahead to the work before the Consumer Health Quality Council. We will expand the Council membership and their voices will continue to play a vital role in the next wave of health reform – as we transform our health care delivery system so that it is focused on patients and our overall health. The Consumer Health Quality Council will be in the midst of that work here at HCFA and around the state.
This also seems a good moment to share a few of their cool links:
Patient and Family Advisory Councils — Does your hospital have one?
Have you had a negative experience at a hospital, and do you need help navigating its customer service? Check out The Assertive Patient.
And, frightening but important, the council has created a “story bank” of patients harmed by their treatments. Check it out here.
Health Care For All, the group that represents consumers in the health care system, sounds cautiously optimistic, and offers this pithy distillation: the governor’s plan could mean “Lower cost, better care.”
Even here in Massachusetts, in the state with the most insured people bar none, there are still at least 20,000 children who are not covered. Why, oh, why, with all the help available, are there still children without health insurance?
“We ask ourselves this question every day,” said Dayanne Leal of the advocacy group Health Care For All. Today, Leal and a team of 13 volunteers are trying a new tactic to get children signed up: A “got coverage?” phone-a-thon, from 9 a.m. to 9 p.m., inviting anyone who still has uninsured children or teens to call 1-800-272-4232 and get help signing up. More than 40 children have already been enrolled, Leal said at noonish today, and about a hundred messages are still pending.
“It’s going crazy, which is good,” she said.
So why is it? Why haven’t these children been signed up already? Continue reading
Massachusetts led the way toward getting more people covered by health insurance, but recently it took a notable step in the other direction.
As of July 1, about 700,000 poor adults statewide lost their dental coverage through MassHealth, the public health insurance program, as a result of budget cuts. CommonHealth asked Christine Keeves of the advocacy group Health Care For All how the cuts were playing out.
Q:What are you seeing as a result?
A: Health Care For All has a HelpLine that can answer general insurance questions, tell folks what free and lower-cost programs they may be eligible for, and help them to apply all in quick and easy telephone call. They have experienced a spike in calls now that the cut has been made. Our Helpline counselors have already collected stories from every corner of the state from MassHealth members who are in pain, unable to eat, sleep, or work because of dental pain, and who are getting sicker and sicker while they try to find care.
· A Worcester woman, pregnant and on disability, needs two root canals that she cannot get because the procedure is no longer covered, which is endangering the health of her and her unborn child.
· A Mattapan man who has had 8 extractions cannot get the dentures he needs not only to go on job interviews (which we all know is incredibly important, especially in the current economic climate), but also for such basic functions as eating and speaking.
· Our Helpline counselors are in the process of assisting a Springfield woman who is mentally ill and diabetic. She had to have all of her teeth pulled in June. In light of this cut she is unable to get dentures. Her doctor warns that she will die without the dentures. Continue reading
As the new and expanded CommonHealth gets rolling, we’ll be asking people with their fingers on the pulse of Massachusetts health care reform about the current state of play — and what comes next. Pulse-wise, Brian Rosman, research director at the advocacy group Health Care for All, is an advanced oximeter (that high-tech clothespin they clip on your finger.)
His top five picks for why the state legislature ended its session this summer without the promised advances on changing the payment system:
1: Time simply ran out. General state issues took more time than expected, particularly the casino question and a budget that was more complex than usual.
2: Shorter-term cost controls demanded too much attention. Efforts to provide fast rate relief to small businesses and individuals tended to dominate. But everyone knows payment reform must come. At the signing for the insurance bill, which would normally have been a time for self-congratulation, everyone was saying instead that it was not enough. Senate President Therese Murray promised that payment reform would be her top priority next session. Ronald Mariano, assistant majority leader of the House of Representatives, declared, “The days of fee-for-service are over.”
3. Lack of consensus: Historically, Massachusetts has passed its groundbreaking health care reforms with the agreement of a broad consensus of politicians, employers and medical providers. On payment reform, no such consensus exists yet, and forging one will take serious time and effort.
4. Uncertainty over the effects of national health reform. The national reform bill sets up a “Center for Medicare and Medicaid Innovation” that will let states try out reform models, but the center won’t start up until January. Its role will affect what states do.
5.Disagreement about oversight and accountability. How much power will the state have over the rates charged by insurers and providers?
Coming up on CommonHealth: More Top Five lists of payment reform sticking points, and possible ways past them.