When President Obama came to Massachusetts to rally the troops for Martha Coakley Sunday, he had little to say about health care. That was curious, considering that the White House needs Coakley to keep his filibuster-proof Senate intact so the health care bill makes it to the finish line. It’s also puzzling considering that for weeks health care has been Topic Numero Uno, and the president has been working behind the scenes to shape the legislation.
In his remarks, the president noted that Coakley as attorney general had gone after big insurance companies that misled people into buying coverage, only to deny it when they got sick. Later in his talk, he told the crowd that when it comes to taking on the worst practices of insurance companies that routinely deny Americans the care they need, she’s going to be on your side. That was pretty much it. No mention of how Massachusetts reform became the model for national legislation; no mention of the state’s high cost of medical care; no mention that many residents have dropped coverage because they can’t afford it and are willing to take the penalty; no mention that small businesses are struggling mightily to pay their premiums.
It’s not unreasonable for Massachusetts residents to want their U.S. senator to be on their side, especially when it comes to the state’s soaring cost of health care—an issue simmering beneath the surface, even if it hasn’t quite bubbled over as a major issue, in Coakley’s campaign against Republican Scott Brown. “Small businesses are mad as hell,” says Jon Hurst, who runs the Retailers Association of Massachusetts, a trade group of some 3000 firms. “This is by far the worst year we’ve seen since the [reform] law has gone into effect.” Hurst is talking about the double-digit insurance rate increases his members are seeing in renewal envelopes. The premiums for his own five employees have jumped up thirty-three percent. The next logical step, he says, is a high deductible policy to bring down the price.
Bruce Derosier owns a fitness center in Spencer, a town of about 13,000 in the middle of the state. The premium for his individual policy was affordable at $1,800 nine years ago, but the $9,100 he pays now is not. His agent found him a similar Blue Cross policy for about $6,000 a year, but warned him it was an introductory offer and that the price could go up next year.
Bob Cirba, a painting contractor from Spencer, and his wife, Joy, just got word from their agent that Blue Cross was increasing their premium from $1,002 to $1,594, a 59 percent hike. And that’s for an HMO with a deductible of $1,000 for each family member. “It’s not realistic that a family of four in middle America can come up with over $1,500 a month just for health insurance,” Joy said. They are weighing their options. In western Massachusetts, Terry Carlo and her husband weighed theirs, and last month dropped their policy when the premiums rose thirty percent. Says Hurst: “Providers have gone unchecked because the insurers are more or less working for providers not subscribers. A year after the handshake we’ve made no progress, and that’s discouraging.”
A few days before the president’s visit to Boston, Christy Mihos, a Republican candidate for the governor’s race next fall, issued a press release that got little attention, but asked a crucial question: What happened to the attorney general’s investigation of Partners HealthCare, the state’s biggest health system, and Blue Cross Blue Shield, the state’s biggest insurance company?
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While wading through the confusion of this year's healthcare debate, every now and then a few things pop up that make the rest of it much more clear. For example, this statement explains to me why natural enemies, doctors and insurers, seem to be allies in this round of health reform: "Providers have gone unchecked because the insurers are more or less working for providers not subscribers." A similar ah-ha moment occurred around mid-summer when a mini debate about Medicare Plus 5 revealed a major but under the surface squabble: doctor dissatisfaction with Medicare reimbursement rates. As a consumer, I typically hear about insurance companies as the villains because they interfere with doctors' judgments about patient care and pressure patients into less costly treatment even if doctors deem it medically necessary. But I have not been hearing a lot about doctors making more money from non-Medicare patients, in spite of all the hassles with the insurance companies (I know they often turn away Medicaid patients). To me that explains some of this year's dead-ended approach to health reform (ya ya ya there are some good parts but the whole efforts falls far short of what's really needed). So now I'm trying to understand the politics of Medicare reimbursement. I heard that the creation of Medicare actually built the great wealth in American medicine so now I'm trying to reconcile that pre-existing perception with this new(ish) to me info.
I'm also trying to understand Atul Gawande's statements from a recent broadcast of Democracy Now about his experience with mandated insurance in Massachusetts. When Amy G asked him about Steffie Woolhandler's (his colleague from Massachusetts) description of it as a failure in achieving universal, affordable care, Atul G replied, "Dr. Woolhandler and I disagree on this." [http://www.democracynow.org/2010/1/5/dr_atul_gawande_on_real_health] I am puzzled. Are the outcomes of the Mass initiative a matter of opinion? Or are they measured by facts (such as rising rates, dropped policies etc)? He explained a reason for satisfaction is that as a surgeon he now no longer comes in contact with extreme dramas about denied care. But has he also experienced enhanced reimbursement as part of his own improved experience as a provider in Massachusetts?? I mean no slight against Dr G, he's a constructive, informative part of the debate. I just don't fully understand how doctors are compensated when they practice in large academic health systems. Salaried only? Salaried plus reimbursement per procedure? Reimbursement only?
#1 Posted by MB, CJR on Tue 19 Jan 2010 at 12:49 PM
As I have posted before, the solution to the national healthcare quandary, is state Medical PSC's, a.k.a. state Medical Price Commissions. These commissions will set fair and reasonable prices for all private insurance billed medical services. (Since the insurance companies fail to elicit fair pricing through their contracts, the commissions will do the job for them.) Also the PSC environment eliminates all service contracts and provider networks. This cuts insurance costs significantly and these savings can be passed along to policy holders. I tell you, this is the solution we need! Each state PSC will look out for its citizens or the voters will replace their commission membership.
Cutting healthcare costs will expand healthcare in itself. Policy prices will come down and put money back into the policy holders' pockets to help end the recession. The provider's are being overpaid and can afford to live a less lavish lifestyle. Get involved in your state and start pushing for a PSC. I am doing this in my state.
P.S. - Massachusetts will not solve their healthcare cost problems until they establish a state price commission which will get their medical prices down to what people can afford.
#2 Posted by Dan Smith, CJR on Wed 20 Jan 2010 at 09:02 PM
Dan Smith and MB above both make very thought-provoking comments; thanks!
Re this post's sub-title "What's bothering folks up there, anyway?", I'd say it's much of what Trudy points out in this post. It's also that many voters don't trust what's being said publicly by the health "reformers" (politicians in Congress) when that's placed alongside what's actually being done behind closed doors where the health policy is crafted. The "reform" bills that came out of each branch of Congress favor the interests of the medical-industrial complex above the needs of the average American! Yes, there's some good in each bill but there's a lot that's pretty awful.
I consider myself an Independent and that's my baseline political registration here in Massachusetts. I'm a creative thinker who values humanitarian ethics blended with fiscal responsibility. I've worked in health care for 30 years, 15 of those as a Master's prepared nurse.
I'm one of the 60-70% of voters who support a "robust" public option in health reform. The majority of voters recognize the value of this cost-saving option. Many of us who are under 65 want the option not have our healthcare dollars run through a private insurance company.
Why not explore the common-sense solution of looking at how to improve Medicare so that it's both more comprehensive in benefits and standards to not pay in open-ended fashion for unneccessary and/or harmful medical services (e.g. the McAllen TX phenomenon as profiled by surgeon Atul Gawande in the New Yorker)? Then open up Medicare to all who want to pay in.
American Medicare for all who want to participate is an obvious policy option for national health system reform.
I predict there will be a growing demand for the choice of a more cost-effective model of providing comprehensive health insurance, such as improved Medicare-fo-All.
Bold and sustained leadership from our elected leaders to make this reform happen would be the real silver lining in the Massachusetts vote.
#3 Posted by Ann Malone RN, CJR on Thu 21 Jan 2010 at 03:48 PM