From the No Harm In Trying The Obvious Dept. …. A while back I said Charlie Baker had failed to justify his existence — well, to be nicer, and more accurate, his company’s existence. Why must we have health insurers at all? But in reading the must-read MassINC article on health care costs, I thought of something he could do … trouble is, it’s been done — sort of. And according to Baker, folks didn’t like it.
Harvard Pilgrim is a major consumer of health care on behalf of its members. It pays the bills. It stands to reason that it doesn’t want to pay more than it has to, but Baker complains that it must, even though HPHC has no idea what it’s paying for, or how valuable it is. There’s seemingly infinite demand for treatments of tiny marginal value over cheaper ones, and more expensive docs and drugs.
Well, OK. Instead of waiting around for the state to publish cost and quality data (at the cost of somewhere between $200,000 and $2 million — who knows this?), why doesn’t Harvard Pilgrim collect its own data — and share it with the public? Does Harvard Pilgrim have $2 million kickin’ around somewhere? (And why pick on Charlie — what about the Blue Cross Blue Shield?) They already do this for the Group Insurance Commission, which then leverages the information to get better deals for state employees. What’s preventing them from doing it for themselves?
According to Baker, folks didn’t like that:
I?m not trying to pass the buck when I suggest that the public sector has a major role to play in making this happen. Health plans are not viewed by the public at large as disinterested players in the health care game. Most people think we have a vested interest. Ten or fifteen years ago, health plans did try to define ?medically necessary care? and ?evidence-based care,? and people hated it. We were the bad guys ? denying people access to care and services. Any attempt to get serious about measuring performance, studying best practice, and engaging the public debate around what should and shouldn?t be funded has to come from either the public sector, or from the plans in conjunction with others.
The reason I like an Institute for Health Care Delivery, built along the lines of the other Institutes of Health, is because the feds fund the research, but the work gets done by clinicians and researchers. Docs, researchers and hospitals studying and reporting on health care delivery, thereby establishing standards of practice, is a much more effective way of engaging the debate and getting something done than an approach that involves the health plans on their own.
I don’t know — how about making a number of plans available out there, one with savings based on publicly available quality and cost data, and the other based on our current voodoo system? That would be interesting, and relatively non-coercive. Has that been tried?
We keep hearing that there’s no constituency for dealing with health care costs. I don’t believe that. Every single employer who offers insurance has to be part of the constituency — it’s big, big money out of their pockets. Every employee — every dollar going toward health insurance is a dollar not going into your pocket. Every patient — we pay for it in co-pays and cost sharing. Every shareholder of every company that isn’t directly in the health care industry ought to be part of that constituency. That’s most of us — even in a state heavy in health-related industry.