Patrick/Murray Health Care Working Group

Comments

1. john-howard says

   December 6, 2006 at 5:45 pm

   Apparently a huge chunk of our premiums go to drug companies to pay for presecription drugs.  This is partly to pay for the cost of the drugs, but mostly to pay for ongoing research into new drugs.  Do we want so much of our premiums to go drug companies?  Do we need to subsidize their research this much?  How much could premiums be reduced if we had some way to choose plans that did not offer presecription drug benefits, or limited the choice of available drugs under the plan to those that have already been developed? 

2. annem says

   December 6, 2006 at 8:08 pm

   As part of my comments at the HC mtg at Dimock yesterday I suggested to both the HC work group members and to the public that http://www.BlueMassGroup.com was a lively source of discourse on health reform issues, as well as suggesting Defendhealth.org and MassCare.org for health reform data and policy critiques.

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   john howard I hope you submitted your important comment on pharma costs by email to the HC work group.  here’s that address: patrickmurrayhealthcare@gmail.com

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   jim hunt who posted this diary didn’t seem to include the email info but I rcv’d it and was asked to share it for community outreach/public input. from jim’s post it looks like others’ comments can be posted on BMG and/or submitted using the email if you prefer.

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   as mentioned, I attended yesterday’s HC work group mtg at Dimock.  a good turnout, maybe 100 or so folks.  about a third signed up to speak, including me.  as you might expect I addressed the urgent need to improve on the flawed Chap 58 health law and to tackle more fundamental health system reforms (addressing access, cost and quality in an inter-related fashion) that are paramount if we are to achieve successful sustainable universal health coverage/health care security for all in the state.

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   I said quite a bit more (in my 2 minutes) which seemed to resonate with the audience, at least. I only hope that everyone’s comments were seriously listened to and will be reflected in the final report due from the HC work group to the Patrick/Murray team by Dec 15.  A tall order.

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   It was announced that the final report will not be a public document.  That news was met with quite a bit of grumbling and some serious dismay.  Thoughts on that?

3. johnk says

   December 7, 2006 at 3:27 pm

   1. 

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   I was recently in a physician’s pratice, it reminded me of someting that had troubled me for a long time.  A sign on the registration desk with what healthcare insurances that they do not accept.  In this paticular instance it listed all Medigap insurances for the state.  So what they are saying is: if you are a senior we don’t want you here.

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   The same issue with MassHealth, finding physicians in a practice that accepts MassHealth is often difficult.

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   In these two scenarios some physician practices are systematically not allowing seniors or low income families to be part of their practice. You use Medigap insurance for annual checkup and other items not covered by Medicare, they provide benefits for preventative health.  By not allowing coverage for well visits they are pretty much cutting them out. 

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   Go to a clinic not to our practice is something I think should be looked at in the start of this administration.  Is the issue compensation with Medigap?  Do they pay like they should?  I don’t exactly know.  But maybe applying some pressure on these groups to ensure that groups are not closed out from practices is a good start.

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   2.

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   Standarizing state agencies (MassHealth, etc.) with standard insurance guidelines defined under CMS.  All commercial insurances and Medicare follow these standards for reimbursement and clinical coverage under Medical Necessity.  As I understand the Uncompensated Care Pool is ready to get a work group together on the claims
   processing requirements following Medicare’s guidlines. Now I believe that this is limited to transaction sets, but it’s a start.  At this point the work group has not started so I do not know if they are going to “shoehorn” what they do now in a standard format or if they intend to follow the principles defined under Medicare.  I am hopeful, but I wanted to note this here as something that will reduce costs and streamline the process at the DHCFP.

4. charley-on-the-mta says

   December 7, 2006 at 11:34 pm

   Hopefully it’ll be ready tomorrow.

5. annem says

   December 11, 2006 at 3:15 pm

   Some final input from one exceedingly concerned citizen who is also a nurse and a health reform/health justice activist of two decades (starting around the time that my sister developed schizophrenia). Please also see below another input comment from a different citizen, Mr. Benjamin Day, that is cross-posted onto this thread to make sure that jim hunt and EVERY OTHER member of the HC work group see it.  Thank you.

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   I would like to reinforce the important recommendations that appear in the below comment to enact legislation to address these 3 components of fundamental reform:

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   – Uniform billing
   – Capping Overhead/Administrative/Advertising spending by health insurers (and this requires creating a standard definition of Admin. spending which does not exist at present)
   – Bulk purchasing with price negotiation for more affordable prescription drugs for the people of MA.  Joined with this, take the bold steps to create a true health system that emphasizes HEALTH and reduces the need/demand for such drugs.

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   Which leads us to the need for high-profile public hearings and honest, vigorous public discussion about the merits of the Health Care Constitutional Amendment and the Massachusetts Health Care Trust bill that seeks to create a true universal coverage program with streamlined financing.

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   I also want to recommend for consideration for the post of Secretary of Health and Human Services these individuals:
   -Judith Kirland (has effectively held many local, state and regional HHS-type positions over her career.  Has very solid humane values and HHS academic background, I believe)
   -John Auerbach (from most accounts is a very effective Commissioner of the Boston Public Health Commission, and is a progressive, humane values person.  Academic backgound MBA and ?)
   -Deborah Enos (long history with and now President of Neiborhood Health Plan, where I get my family’s health insurance from.  NHP seems the most sincerely people-centered insurer, and not primarily for marketing or cost control reasons but because being people-centered makes sense for health care. Controlling costs is good, but it is not not the end all be all.  She has her MPH)

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   Here is Ben Day’s input and the link to the original HC post by Charley on BlueMassGroup.

   Health Care on a Pale Horse posted 12/10/06

   Hi Charley and Commenters – thanks for posting such thoughtful and extensive reviews of the health care issues facing the Patrick administration.

   When we look at the state subsidy component of the bill, which offers some form of financial aid to individuals up to 300% of poverty, it’s important to be aware that many similar bills have been passed in other states, some less ambitious and others much more ambitious than the Massachusetts plan. None of these laws have been able to reduce the percentage of the population that is uninsured – much less approach universal health coverage – which does not mean that they aren’t working, but just that the health care crisis is moving faster than the public health programs trying to catch up with it.

   The Washington Basic Health Plan way back in 1987 tried to subsidize health insurance for all residents up to 200% of the poverty line. But there was a funding shortfall early on, and presently enrollment is capped at 125,000 with another 400,000 or so eligible but unenrolled.

   The most important example, Tennessee’s TennCare, attempted to subsidize insurance up to 400% of the poverty line, and actually succeeded in enrolling 400,000 uninsured people under the TennCare expansion. However, when you look at the whole population, while the rate of uninsured dropped from 14.7% to 11.2% following the first year of implementation, the very next year the uninsurance rate jumped right back up to 16.4% and has stayed there. Last year, one out of every four Tennesseeans under 65 were enrolled in Medicaid – an unprecedented level of public support – and yet a single year of the normal progression of the health care crisis was enough to wipe out the gains of the country’s largest public health care expansion.

   Even here in Massachusetts, a massive MassHealth expansion added over 300,000 uninsured residents to the public rolls, reducing the uninsurance rate here for several years. But just two or three years later, we were back to where we started, and the uninsurance rate in Massachusetts has actually risen much more steeply than the national average in the last two decades, and we have lost more ground even than Texas or Florida (with the highest percentages of their population lacking insurance).

   The basic lesson is that even massive expansions of public health insurance programs are not able to even make steps towards universal coverage, and it is disingenuous to pitch them as such – although every such bill ever passed is covered by the media as a universal health care initiative. What they actually represent, are vitally important damage control measures for the uninsured. We need to support these efforts, but we also need to work towards truly universal, comprehensive coverage – and incremental expansions can’t get us there.

   We face even more of a challenge in Massachusetts because our incremental expansion bill doesn’t even attempt to control costs. Most similar bills in the past have been premised on reinvesting savings or generating new revenues of some sort – either from moving medicaid recipients into managed care plans, or from new tobacco taxes. But Chapter 58 contains shockingly little financial framework to support its mostly worthy exterior. But this, nonetheless, will put Chapter 58 firmly in the tradition of previous incremental expansions, all of which run up against budget limitations before they can make an enduring dent in the uninsurance rate.

   The individual mandate on the other hand represents to me an extremely disturbing trend in health care reform. The “personal responsibility” rhetoric springs from the attack on welfare – recall that the Personal Responsibility Act was one of the ten platforms of Newt Gingrich’s “Contract with America.” (Read AFL-CIO President John Sweeney’s original [ press release http://www.aflcio.or…. ] criticizing the bill, expressing shock that Massachusetts would take a page from the Gingrich playbook.) Personal responsibility has been adapted for the health care realm in the shape of High-Deductible Health Plans and HSAs (for private insurance), Medicaid reforms that attempt to force enrollees to abide by “personally responsible” behavior or lose their benefits (for public insurance), and individual mandates (for the uninsured). Although sometimes couched in progressive terms as if only the well-off with discretionary income to spare will be affected, the measure in reality targets the lower middle-class, which is increasingly affected by uninsurance and underinsurance because they are less and less able to afford it.

   There is a whole body of research showing that the American middle-class is increasingly shouldering unsustainable levels of debt, and is losing its capacity to save and weather financial disruptions (spells of unemployment, unexpected costs, etc.) See the report [ Middle Class in Turmoil http://www.americanp…. ] by the Center for American Progress for some truly disturbing figures about the financial insecurity of the middle 60% of Americans.

   I would offer the brief correction that the merging of the non-group and small group markets will not “lower premiums” – it will lower premiums for the non-group market (individuals), but raise premiums for the small-group market.

   The $56 billion question then is how do we control health care costs in Massachusetts? Most of the measures that states have turned to in the past have had limited or no success. We know that single payer systems are vastly more efficient, and they are the only systems with a track record of achieving universal health care (there are no counter examples in the history of the planet, thus far). This might seem like a difficult political struggle, but it beats struggling for reforms that don’t work.

   Many of the smaller steps that Charley mentions in his initial post I believe point towards single payer in that they attempt to consolidate and streamline health care financing, taking some of the rough edges off of our fragmented, immensely wasteful system.

   Senators Steve Tolman and Bruce Tarr have a bill, for example, that would bring a uniform billing mechanism to all insurers and providers in Massachusetts.

   Senator Pat Jehlen has a bill that would, as Charley describes, impose a limit on how much insurance companies can waste on overhead expenses, so that a higher percentage of our premium dollar would actually go towards care.

   And Senator Montigny has in the past sponsored a bill for bulk purchasing of pharmaceuticals.

   It’s unclear how much cost savings we could actually get from such measures – they would be steps in the right direction, and they deserve far more attention than they have received in the public eye. But there is really no substitute for the single payer option, which allows for global budgeting – the golden arrow of cost control.

   We have a saying in the single payer movement that hails from David Lloyd George: “You can’t cross a chasm in small steps.” But you can of course try to keep from falling in until you’re ready for the leap!

   (All of this information on the new health care law and more can be found in Mass-Care’s new powerpoint presentation on Chapter 58, available by [ clicking here http://www.masscare….. ].

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   Thank for your serious consideration of this input and its inclusion in the Final Report of the Health Care Working Group.

6. tgmhealth says

   December 15, 2006 at 9:45 am

   Thanks Jim for giving us this opportunity to make comments.  The comments so far have been good.

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   John Howard brought up a real problem with prescription drugs (too expensive).  But, rather than “opt-out”, the working group should “opt-in” with setting up a prescription plan using bulk buying to reduce cost.

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   Requiring a cap on administrations charges will also reduce costs.

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   And I know this is a tough one but you will have a hard time implementing an affordable plan without a larger contribution from the business community.