THERE IS A LOT OF TALK ABOUT THE NEED TO CONTROL HEALTH CARE SPENDING ACROSS THE COUNTRY…BUT PARTICULARLY HERE IN MASSACHUSETTS WHERE THE COST OF COVERING THE UNINSURED IS THREATENING THE PLAN ITSELF.
There has to be climate change, otherwise our health care reform will implode under the costs.
THAT’S SENATE PRESIDENT THERESE MURRAY WHO FILED HER HEALTH CARE CLIMATE CHANGE BILL YESTERDAY. IT IS A BROAD PACKAGE THAT INCLUDES NEW REQUIREMENTS, MORE STATE SPENDING, GREATER SCRUTINY OF HEALTH CARE COSTS…AND THE HOPE THAT SPIRALING HEALTH COSTS WILL START TO UNWIND.
BEBINGER: Senate President Therese Murray is worried about spending on the state’s health coverage law…and she calls this bill health reform phase 2. It aims to control health care spending for and by everyone.
MURRAY: Health care costs have become the no. 1 issue facing our economy. These costs are not only squeezing our state finances, but they are also making it increasingly difficult for young people for families and businesses large and small and municipalities to make ends meet.
BEBINGER: Murray explains her bill as many parts that as a whole will reign in costs and improve the quality of health care in Massachusetts. She’d tackle a shortage of primary care doctors with expanded tuition incentives, loan forgiveness programs affordable housing options and by recognizing nurse practitioners and physician assistants as primary care providers. Murray would require that all insurers create uniform codes and billing to cut down on administrative costs. Doctors, hospitals and clinics statewide would have to switch to electronic medical records by 2015…and prove they know how to use them to register as physician. Massachusetts Medical Society president elect Bruce Auerbach supports much of what’s in the bill, but questions the electronic medical record requirement when the bill doesn’t boost reimbursement rates for primary care doctors.
AUERBACH: If we don’t even have adequate reimbursement to support the physician practice thinking that there is this additional money to propagate electronic health records is another step away.
BEBINGER: Murray is pledging 25 million dollars a year to help providers adopt electronic record software and systems. She’d raise the cigarette tax to fund that and more. The state’s E-Health Collaborative estimates it will cost about half a billion dollars to bring everyone who isn’t using a connected computerized system on board. Two other key pieces of Murray’s bill add more state scrutiny and oversight of health care spending. The Senate President wants to review the rules about how much insurers and hospitals hold in reserves and she would require public hearings if insurance premiums are projected to rise more than 7% a year, to find out why.
MURRAY: There hasn’t been enough oversight to find out what those cost drivers are. How much do you spend on marketing, how much is in your endowment fund, how much do you need in surplus and reserves. Those are the questions the public wants to know and the Commonwealth is a big purchaser of insurance.
BEBINGER: Many insurers and providers say they welcome the chance to clarify what is driving health care costs. But Tufts Health Plan CEO James Roosevelt says there is some concern that Murray is moving towards the state setting health insurance rates.
ROOSEVELT: Transparency and putting forward the drivers of costs is useful. Creating a new process for approval of rates could not reduce costs but create a new bureaucratic scheme.
BEBINGER: Looking at what drives health care costs is just the first step in figuring how to hold down increases. But Jon Kingsdale, who runs the Health Connector and is under a lot of pressure to reign in spending on the uninsured, says scrutiny is a critical first step.
KINGSDALE: The no. 1 obstacle to cost containment is if people do not understand what the issues really are and what some of the options are. You know, you can’t treat the patient unless you make the diagnosis first and in medicine that’s often the most challenging.
BEBINGER: Some health care economists say the only way to contain health care costs is to limit services…particularly the more expensive ones. Stuart Altman, the dean of the Heller School at Brandeis University says Massachusetts should be looking at a cost control strategy the federal government is reviewing…called comparative effectiveness.
ALTMAN: To try to understand better which services are really that valuable to justify their high cost and which services we could either do without or use a different procedure to do the same thing.
BEBINGER: But Altman says the Senate bill strikes a good balance.
ALTMAN: It touches on a no. of the key areas that many of us have been pushing without generating attacks on the legislation.
BEBINGER: The Massachusetts Biotechnology Council is upset with a proposed ban on gifts from the pharmaceutical industry to physicians…and the bill leaves out any changes in medical malpractice law which many physicians have been urging for years. Murray says she expects the bill will change during debate in the Senate and in the House. But she wants it to be heard, argued, amended, approved and signed by the Governor as of July, when this legislative session ends. House leaders and the Governor have not said much about the bill and have not agreed to that timeline. But then they aren’t saying it won’t happen either. Here’s house chair of the Joint Committee on Health Care Financing, Patricia Walrath.
WALRATH: Well these are all subject matters that both house and senate matters dealing with health care have dealt with in one form or another and we all know that we’ve got to get a handle on the costs.
BEBINGER: Governor Patrick says Murray briefed him on the plan.
PATRICK: There’s a lot of really good ideas in there and I look forward to working with her on that.
BEBINGER: That’s a better reception that many major bills receive on day one…which is not to say what will happen next week when Senate President Murray’s proposal to contain health care costs has its first joint house and senate hearing.
“Things only have the value we give them.”
Healthcare has always failed to align its incentives for all stakeholder simultaneously.
We had DRG’s introduced in the 1980’s to curb hospital spending, but the doctor’s weren’t similarly affected and so hospitals and doctors were at odds. Then we had tight managed care in the 1990’s, but the patients weren’t similarly affected, so we had the doctors and the patients at odds. Now we have high deductible health plans and patients who are squeezed financially won’t get care they need (e.g. NEJM’s recent article on compliance with mammograms in Medicare patients who now pay copays) and doctors again fight with patients, but this time to go get the care. Clearly, a one-size-fits-all approach to what consumers should share is easier to create, but it ignores the realities of what is truly needed by whom (some high cost imaging is unnecessary and some is very necessary so making all pay a high copay to decrease utilization will come back to bite you).
We have insurance companies wanting patients to do risk assessments or else they will financially penalize the patient’s physician, again putting a wedge between patients and physicians. We allow constrained formularies in the name of holding down costs, but then cloak the savings in secrecy of pharmaceutical companies, pharmacy benefit managers and insurers so we don’t know who actually reaps that savings. We can’t negotiate drug prices or see all the costs, because…well, it’s just not American. Let the market do its job, as long as corporations don’t have to come clean or give up their subsidizes!
We have patients who demand brand-name only drugs, and patients who demand immediate subspecialist care for simple problems, like acne or constipation, when a knowlegeable primary care provider can provide that care for a third the fee and without adding to bottlenecks in the subspecialty system. We have patients who demand to see the sports physician when a general orthopedist would do just as well. (By the way, comparing our costs to the lower costs of other health systems, which are primarily run on primary care, is comparing apples to oranges.)
Insurers look at the claims history of the group that people belong to and use that info to set the following year’s premium for that group, so wasteful consumer behavior drives up costs for everyone. But there doesn’t appear to be much consumer understanding of how their behavior drives health care costs, or much appetite to be the bearer of bad news and explain it clearly to them.
Some companies who self-insure have learned that accepting short term costs for long term savings make sense, so they move the chronic care drugs and supplies to Tier 1 of their formularies, brand name or not, and give their chronically ill employees breaks on co-pays for follow-up care and testing to encourage them to stay on top of their illnesses. But the insurers don’t have similar long term “skin in the game” for any given beneficiary, so they focus on the short term costs and don’t always enact reasonable policies to manage their insured lives.
Massachusetts requires insurers to cover infertility treatments and in 2000 Massachusetts had the highest number of multiple births to older mothers. Multiple births can lead to expensive NICU stays and higher medical costs long term for the child, as well as to higher infant morbidity and mortality. We have to decide what we want to pay for, and understand what the unintended consequences of those decisions may be.
The reality is that there will never be a free lunch when it comes to healthcare, so we need to decide how valuable is our health and what we want to spend to maintain or improve it. And, yes, we also must get the waste out of the system, which means targeting all its sources–pharma, insurers & PBM’s, hospitals, clinicians and patients, in lieu of the prior technique of locating a cost-cutting target du jour.
Whle insurance companies may only spend 15% on administrative overhead, but just one CEO in one insurance company reaps a compensation package worth $1.5 billion and cash bonuses of $5 million a year two years in a row, think of how many kids that could insure, 15% total administrative overhead or not! It’s hard to imagine that some re-engineering in that regard won’t help contain costs. Same for hospital CEO pay, it’s hard to be happy about understaffed wards when you realize the amount of money the execs are pocketing.
Certainly all things are relative. We think nothing of spending $150 a month to get our hair done, then complain about $15 co-pays for medical care. Many primary care doctors, especially in Massachusetts, are not making the exorbitant sums that people think they are making, because they are paid minimal amounts for visits and they aren’t paid anything for much of the work they do (referral paperwork, phone calls, etc.).
It’s been said that “The first step in wisdom is to question everything–the last is to come to terms with everything.” Let the journey begin.
What a bunch of gobbelby-gook. People can’t afford the insurance at the present costs (before the proposed 14.3% and doubling the copays for C. Care and the 5% increase for C. Choice) and they are paying penalties that they can’t afford either. Property taxes just went up sky high, gas is on the rise along with heating oil and food and all you people can do is chatter back and forth about training some doctors, cost transparency, etc.
People are hurting but that makes no nevermind to a single one of you.
By the way, I haven’t been to the hairdresser in 6 years, don’t belong to a gym, put the garbage out for pickup every other month, have the heat turned down to 63 degrees so, quite frankly, there’s nothing left to cut back on. And my state senator’s aide had the nerve to tell me to change my lifestyle so I could afford the insurance.
It is quite evident that this is an emperor-has-no-clothes operation. When do you people wake up and realize all you are doing is propping up a failing mess that is hurting at least 300,000 residents with more to come as people are forced to drop coverage to pay for living expenses?
And more importantly, when do you start doing your job which is to represent the people who elected you? We pay your salaries, health insurance and your Golden Parachutes You seem to have forgotten that you work for us. Pull out your copy of the MA Constitution and check out Article VII. Actually, read the entire document and then review the U.S. Constitution while you’re at it.
Then we’ll talk.
Between me and my husband we’ve tried more ways over the years than I can count, including high ferility positions, hormone enhancements, different times of the month, etc. But, the last few years I’ve narowwed it down to one type of treatment. Why? Because I was happy to discover how effective the results were.