Health care reform will likely end up in a cash bonanza for area
hospitals; <a
href=”http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/02/healthcare_reform____with_a_dose_of_profit”>Joan
Vennochi and <a
href=”http://www.hcfama.org/blog/2006/03/will-health-reform-shortchange.html”>John
McDonough have expressed hope that this will end up helping
uninsured individuals, and everyone else, in the process. Vennochi does
a good job running down the pressing questions:
So, how many more Massachusetts citizens will gain access
to health
insurance coverage as a result of this legislation? Are the deductibles
reasonable? Will reasonable health services be provided? Is the
government subsidy big enough to allow those at the lower end of the
income scale to buy insurance? Is outreach aggressive enough to enroll
everyone eligible for Medicaid? Is business doing its fair share to pay
for increased access?
Vennochi is correctly interested in the effect of the legislation on the health and wallets of ordinary people. But will the fabulous — and fabulously rich —
teaching hospitals (like MGH) soak up the money, and the uninsured hope
that they don’t get a bunch of new costs passed on to them?
Since we’ve heard so much about the role of business folks like
Partners Healthcare’s Jack Connors, I’m a little skeptical that so much
more money for the hospitals is the most efficient investment in public
health. While I understand that we all pay for lousy reimbursement
rates for Medicaid, and for the cost of the uninsured, there’s seems to
be no guarantee that providers will reflect improvement in that area
with lower prices for everyone else’s care. It’s still a market for
care, and it seems to me they’ll charge what they can, not what
they have to.
Health care reform should be about healthy people, first and foremost.
That means that you cover as many people as possible first, and
let the risk pool settle itself, evening out costs throughout the
population. The hospitals will get paid in due course, since everyone’s
covered. An analogy is the Earned Income Tax Credit: If you want to
reward work, make it more profitable, and watch the benefits
“bubble-up” within a community and beyond. Lower-income folks win;
Wal-Mart shareholders win. A negative analogy is Congress giving huge
subsidies to oil companies during periods of high prices, ostensibly to
encourage them to produce more, thereby lowering prices. Yeah,
that’ll work.
Sometimes a giveaway is just a giveaway. I fear that the eventual
compromise will shower cash on already wealthy, successful, and
expanding businesses; and leave the rest of us wondering what’s in it
for us. I really hope I’m wrong.
PS: <a
href=”http://www.hcfama.org/blog/2006/04/happy-birthday-healthy-blog-guest.html”>Happy
1st birthday to the Healthy Blog. If you’re interested in health
care issues — and they affect you, whether or not you’re interested —
the blog is a great place to learn. Thanks for blogging, John.
Sometimes, football can be very much like life. There are those football fans who only applaud the long bomb touchdown throw, and there are many fans who appreciate a team grinding out yards on the field, winning the time of possession game, and just moving the chains.
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With regards to the soon-to-be-unveiled health care reform legislation, we understand that access will be improved dramatically. We also understand that Medicaid reimbursements to hospitals will go up. Both of those changes will help reduce costs for those of us who already have health insurance.
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But these changes alone are not the ultimate solution to our health care problems. No one is making that claim. We need to take what we can today, and move on to the next battle – which I believe should be controlling health care costs.
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Carrying forward the football analogy, I hope this is half-time, but I suspect that the clock still has a long way to go.
And I am not opposed to incremental reform, as long as they are increments in the right direction. I just wonder if what we’re hearing really represents an efficient way to invest health care bucks.
when talking about what can and can’t be done, we have to remember that this is politics not physics. a more apt way to phrase it (and to understand it) is as what will be done and what won’t be done.
there seems to be this perception that because of some ethereal force out there we ‘can’t’ have affordable universal healthcare anytime in the near term. well, that mystical confounder is politics. and the influence peddling practiced by profiteers like partners healthcare.
any failure of this legislature to deliver meaningful reform to the citizens and businesses of massachusetts will not because they couldn’t, but because they wouldn’t.
Medicaid payments have been way too low, which everyone in the system agrees on. Basically, it’s a matter of the government getting the best price as the largest payer (which is OK), but then not increasing reimbursements as costs have increased for the hospitals.
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Don’t think that the hospitals will get to keep the money. Given the public nature of the business, the health care companies will have leverage to reduce their payments to the hospitals accordingly, and then their rates will have to come down as well. Of course, all of us out there could go away and ignore the issue, which I don’t think will happen (especially if the new Attorney General wants to make an issue out of it).
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But the biggest issue, one that I have heard John McDonough raise in the past, is that fixing the payment system starts to restore some credibility in the state doing the right thing when it comes to paying for health care. After all, to paraphrase John, why would hospitals and doctors want to negotiate towards a single-payer system when the worst payer under the current system is the state of Massachusetts?
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The next phase of health care reform will deal with improving quality and reducing costs. By owning up to its responsibility to pay adquately for the care that MassHealth is providing today, the state is in a better position to take leadership going forward.