The Globe does a sum-up of the challenges to be faced by the next governor in implementing the new health care law. If you thought this was all taken care of when Mitt had his “Mission Accomplished” mo-mo, think again.
[T]he new administration’s views about how to implement the law, particularly about how much lower-income residents and businesses will have to contribute, will have personal consequences for thousands of people.
“The governor is going to have to display leadership in three areas,” said Judy Meredith, executive director of the Public Policy Institute in Boston, a consultant to nonprofit organizations on lobbying. “Encouraging employers to pay a fair share, encouraging consumers to pay their fair share, and encouraging taxpayers to pay their fair share.”
So the big concept was always “shared responsibility” — everyone kicks in a little. Currently, the law is pretty darned light on employer responsibility, and heavy on the individual and the state. And employers who do insure heavily subsidize those who don’t. Is that fair?
Here’s example: Starbucks insures its front-line workers; I believe Dunkin’ Donuts generally does not. Starbucks and Dunk’s both pay taxes, some of which goes to subsidizing the health care of lower-income folks who don’t get insurance from their employers, i.e. Dunk’s employees. In other words, Starbucks is subsidizing Dunkies. And if the market for lattes will bear it, Starbucks will pass the cost on to you — as if it weren’t expensive enough.
In any event, Gabrieli’s the most aggressive in his stance: He wants to increase the $295 per employee per year assessment on employers who don’t insure. Patrick and Reilly want to work within the current negotiated system, although Patrick seems to grant himself a little more wiggle room.
Whoever it is, the next governor will be gulping a lot of Tylenol over this issue.
More at the Healthy Blog.
got a link for Gabs’ increase? I’d like to read more about it. I’m a Deval supporter, and this is an area where I think Dem leadership could really make a positive difference in the next few years.
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Anyone got linkee?
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Link. Not exactly clear what his proposal is, but that’s what I could find.
eom.
regarding the issues points by the three dem candidates in todays ‘points of view:helathcare’ piece in the globe today, when asked about employer and other assessments, deval patrick says:
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“I am focused on making our system more cost efficient. Massachusetts currently spends 30 cents on every dollar administering the system we have. If we capture those inefficiencies, I believe we can afford the quality and accessibility of care we need and want.”
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this is a very misleading statement, whether intentional or not.
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by saying “massachusetts spends . .”, the implication is ‘the commonwealth’ or the government. which is not accurate.
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the correct statement would have been, ‘ IN massachusetts 30 cents of every dollar is spent administering the system.’
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this is an important distinction that gets muddied up by patrick’s statement. the 30 cents figure relates to PRIVATE and public healthcare spending. the vast majority of that being the former. meaning that every dollar that you pay for your healthcare and coverage, 30 cents (mas o menos) goes to hospital overbilling, middle management deadwood, pencil pushers at harvard-pilgrim, executive salaries, partners’ full-page ad in the globe, and all of the other private insurance/medical industrial complex waste and bloat.
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in massachusetts, as at the federal level, government administered programs (i.e. medicare etc) run at a far greater level of efficiency than the profit seeking insurance co.’s and hospitals and pharmco’s.
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so how is deval patrick going to “capture those inefficiences” in the private sector?
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because turning the thermostat down at the masshealth office isn’t going to do a whole lot.
He didn’t say “The Commonwealth” spends… he said Massachusetts spends. When you talk about Massachusetts drivers, are you talking about state employees behind the wheel?
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I agree that it is ambiguous, and am glad you cleared it up. There are ways to “capture the inefficiencies” in the private sector; and the finance sector has one such method. When you write a check, the recipients’ bank doesn’t track down your bank and demand cash; there is a clearinghouse in the middle — this clearinghouse serves to aggregate the gajillions of transactions, and to compile them in precise lists to be presented electronically to the members. End result: banks get their money faster, there are fewer errors, the data is compiled more cheaply (after all, it has to be written down by one institution, not two), and the system therefore works faster, cheaper, and at a higher quality.
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The same thing could exist for the medical industry. How many times do you get a medical bill before your insurance has payed? How many times do you get multiple bills because Peter and Paul aren’t talking to each other? Problems like this go away with a clearinghouse. This isn’t a proposal for single payer — it’s a proposal to make things appear single payer to the patients because all insurance payments are determined before billing the patient, and the patient writes a single check (credit card, whatever) to a single institution every time. Like check clearinghouses, it would be faster and cheaper for the insurance companies, and have fewer errors and be easier for patients to understand. Why hasn’t it happened? I don’t know. Maybe there’s a lack of leadership, difficulty with regulations and laws, inertia.
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In any case, this is an opportunity for the state to step in and create a clearinghouse (either run by MA or by an NGO or something) and create the laws necessary to run it well. End result? Government has taken action to reduce the 30 cents per dollar that private industry is pissing away.
Who knows, maybe the state could set up a quasi-public institution for the clearing-house and contract the same services out to other states …
“This isn’t a proposal for single payer — it’s a proposal to make things appear single payer to the patients because all insurance payments are determined before billing the patient…. End result? Government has taken action to reduce the 30 cents per dollar that private industry is pissing away.”
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Stomv, why suggest adding yet another type of bureaucracy to our already obscenely fragmented, confusing, and wasteful healthcare system? Is is really too much to expect that those of us who understand the root causes and elements of our current crisis make a commitment to be part of a social movement to really fix the problems. No, it won’t happen overnight, but it CAN happen if we commit to set out on a course to eliminate the middlemen that “piss away” 30% of our health care dollar. The insurance industry and their minions who brought us the uniquely American (and rather grotesque if you really think about it) health insurance phrase of “pre-existing condition”.
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Folks who are interested in this post might want to see health economists Sager & Socolar’s recent report, “Massachusetts Health Spending Soars to $62.1 Billion in 2006″-Spending Is World’s Highest–33% Above U.S.A. Average, An Unprecedented Excess” , 28 June 2006. Report is 86 pages with 40 exhibits posted on their site’s Access and Affordability Monitoring Project (AAMP) page.
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I’d also like to suggest that BMG readers take 5 and visit two useful MA Healthcare Activist websites. This one and this one will go a long way to get you up to speed on MA homegrown universal coverage reform efforts. I don’t call it “single payer”, I call it reforms for “sensible, streamlined financing with public accountability for cost controls, universal access, and quality of care”. Namely, making affordable comprehensive health insurance coverage a permanent right for all. Hey, we’ll be joining the rest of the civilized and wealthy world once we do that! Isn’t that a novel idea?…
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As I’ve learned from others over the years, it is tremendously revealing to apply critical thinking to 2 basuc themes as you evaluate any public policy option, be it healthcare reform or energy policy or military spending. You’ll learn a lot. And you’ll soon realize that our U.S. “healthcare system”, including what we’ve got right here in good ol’ MA, is one of the biggest rip-offs to the ordinary person this country has going these days, in addition to the war in Iraq, of course…
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1) Follow the money trail.
and
2) Who wins and who loses with the proposed reform?
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Last point, I’ve got to identify a fatal flaw/false premise in Judy Meredith’s advice to the next Gov: “Encouraging employers to pay a fair share, encouraging consumers to pay their fair share, and encouraging taxpayers to pay their fair share.”. Hello!! The “consumer” and the “taxpayer” are more often than not one and the same! We’re the same people footing the bill for the myriad cost shifting, profiteering, and bloated bureacracy that characterize our unbelievabley wasteful and often harmful healhtcare system. It’s not all bad; many clinicians give great care and many patients get great care, I don’t want to negate those facts, but we can do SO MUCH better. The real question is who’s got the cojones to take this on as our next Gov?
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I think these 2 quotes from Eleanor Roosevelt capture the basic elements of our healthcare crisis conundrum: “A little simplification would be the first step toward rational living, I think.” and “You must do the things you think you cannot do.”