I was at the packed Gardner Auditorium at the State House this morning for the hearings on the Governor’s health care cost control bill. For so many reasons, this bill, this issue, are the Super Bowl of Massachusetts public policy right now. For all that 2006 was a big leap forward, it is plain as day that health care reform will be a failure without cost control.
What’s your issue in MA politics? Do you care about stuff? The economy? Labor? Education? Taxes? Cost control touches them all:
- Friction between labor and municipalities, the legislature … and people like yours truly. The controversy over moving of muni unions to the GIC is a symptom of skyrocketing health care costs. We can argue about the process question of collective bargaining, but we wouldn’t even be having this discussion absent the crisis of health care costs – aggravated, of course, by decreased revenues due to the economic downturn.
- Tax increases/prop 2 1/2: These are easier to swallow if we are not simply throwing good money after bad. Revenue increases should do more than simply provide the same salaries (or worse), same staffing levels (or worse) and the same benefit packages (or worse), while the extra money is gobbled up by double-digit health care inflation. Health care inflation is squeezing out every other public need and priority.
- Small business needs the relief. Like, yesterday. As the governor said today: If you’re going to grow the economy, you need to grow small business. That means getting some degree of cost certainty for their bennies.
Fortunately, there’s a sweet spot with health care costs: It turns out that the most expensive care is also the worst care (ER care, eg.); while the coordination of care can save money and get better results. Cheaper + healthier.
Dealing with health care finance, without dealing with delivery, is just nibbling around the edges. Of course there’s waste in the finance system: Profit, administrative expenses, bureaucracy. But these aren’t the only drivers of inflation: There are also docs, hospitals, scans, procedures, etc — more and more expensive, and more and more frequent.
As the Gov also mentioned: Responsible cost control is not simply cost exposure for patients. Given the innate imbalance of influence in favor of the delivery side, the onus needs to be on the delivery side to control costs.
I’ll have more about today’s hearing later. Read more at Commonhealth for the general tenor of the proceedings. It was good stuff — there’s reason for hope. Real hope.
stomv says
Here’s a thought: we pay doctors a lot — about five times average salary in US, as opposed to three times average salary in Western Europe. If that ends up being significant money, how do we drive down doctor’s salaries?
Answer: let’s have (a) more doctors, and (b) generate them with less student loan debt. How do we do that? It seems pretty simple to me. We educate more doctors at public universities, and we forgive more of their debt if they can “work it off” in some way which helps drive down costs elsewhere [clinics, whatev].
I’m not claiming with certainty that this would lower total health care costs, but I suspect it might, and would love to see some analysis on what would happen if we graduated 10% more doctors each year, and if those 10% had little to no student loans.