The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

It’s About Controlling Health Care Costs: Learning from Massachusetts

Posted by Alan on October 14, 2007

Massachusetts’ health care reform experiment is nearly 18 months old now. According to an article in the San Jose Mercury News reports some fear “the initiative may buckle under money pressures in coming years.”

The good news is that the program successfully enrolled 200,000 previously uninsured people, virtually all of them in free or heavily subsidized coverage. These tended to be the state’s neediest residents. Those who were ineligible for state help and were uninsured are not flocking into the system, at least not yet.

The problem, according to Alan Sager, a professor of health policy and management at Boston University, is that “We’re covering more people, but it’s not sustainable over the long haul. The law does nothing to control costs.” And there’s the rub.

California may or may not pass comprehensive health care reform soon. The people of California may or may not pass any of several health care reform initiatives which will come to a vote in 2008 to fund these health care reforms. The problem is, that while we call these efforts health care reform, they mostly focus on health insurance reforms. Yes, they include cost containment provisions such as moving to electronic health records, promoting healthier lifestyles and wellness programs, encouraging evidence-based medicine and the like. But the reality is that the population is getting older, new technologies cost more, and consumers expect more from their medical care. In short, the underlying cost of health care is going to continue to increase regardless of what insurance reforms are put in place.

Attacking insurance company practices is good politics — and changes in market behavior are needed. Achieving universal coverage would be a real benefit to millions of Californians. It’s a goal we should move toward as soon as we can devise a workable way to get there. Health insurance reforms are needed (although some of the approaches being advocated are very ill advised). We need to recognize, however, that this approach addresses only a part of the problem, and the easiest part at that. What is most necessary is also much tougher: bringing the rate of health care costs down to something resembling overall inflation. There’s no magic solution for this. It will require tough choices and brave leadership. But as we’re learning from Massachusetts, failure to confront this challenge will undermine whatever so-called health care reform package emerges.


11 Responses to “It’s About Controlling Health Care Costs: Learning from Massachusetts”

  1. How many Americans are long-term uninsured, and not by their own choice? Anyone? Anyone? The ACS says 46 million Americans are uninsured in their propaganda tv commercial. So, I’m just wondering what you all think the answer is.

    Health care should be a state issue. National health care is not prudent. Since when has the federal government ran a program better than a state for the state? The federal govt should run the military, NASA, things like that. Individual states should govern on the state level.

    That’s the way our country was set up.

  2. Matt said

    That makes perfect sense, Bob. Thank you for clearing that up. Canada’s HealthCare system doesn’t allow its citizens to buy private health care? That is sad because what if you make a lot of money and want the best care. You can’t even get it. GOOD POINT BOB.

  3. Bob Copeland said

    No. What I meant was that those with money should be able to buy more care than whatever base plan the government comes up with. For example, its my understanding that Canadians cannot privately pay for care. If their provincial system doesn’t provide it to them, Canadians are not allowed to privately pay for those services. That is one reson why so many come to the US for services.

  4. Bob Copeland. “I believe that the only long-term solution is to ration care and allow those with an ability to pay to buy more care than what the base plan allows.” Just becuase you have money doesnt mean you should pay for a plan you don’t need. Is that what you meant by that statement?

  5. Bob Copeland said

    It is unrealistic to expect that the country can afford to pay for all of the healthcare that we may want sometime in the future unless taxation grows to suffocating levels. There is simply not enough money in the world to pay for all of the health care that we will ultimately need.

    As our population grows, we add millions to the eligibility lists.

    As medical care improves outcomes, we add millions of people to the alive but impaired lists that will continue to incur ongoing health costs.

    As families break apart or move apart, we hire outsiders to provide care to those who formerly would have received care from family members, thus increasing health care spending.

    Limiting or reducing payments to physicians will result in lower quality care as the best and the brightest will not continue to go into the medical profession. The same is true if we turn to a single payer system which will have the ability to curtail payments to providers.

    I believe that the only long-term solution is to ration care and allow those with an ability to pay to buy more care than what the base plan allows.

    We have to decide whether it’s smart to pay for heart by-passes for those over age 80. We have to decide whether it’s smart to spend hundreds of thousands of dollars saving premies or crack-babies. We have to decide whether we should fix “tennis-elbow” or just tell someone to take up another sport. We have to realize that bad luck does occur and that spending millions of dollars to fight it doesn’t allow us to use the money more effectively to help hundreds of others.

    We have to recognize that our ability to fund is limited but that our ability to spend is unlimited.

    To those who believe that we have an unlimited well to tap into to pay for medical care, I encourage them to do the math. An aging population, being kept alive, but, not well, will continue to demand ever increasing costly care that will outstrip the economy’s ability to keep up.

  6. Matt said

    StruttinWolf. It is possible to have coverage for everyone and thinking this doesn’t make some an idiot. Obviously this will cost a lot, but that doesnt stop people from flying to the moon or driving a $1,000,000 sports car. Health Care for all is important and obviously expensive. Calling Cliff an idiot weakens your point. If EVERYONE did their part, Health Care for all is an obtainable goal. And last time I checked our government was in debt becuase of things that are COSTLY and IMPORTANT.

  7. Cliff. This shouldn’t be about costs? I’m sorry, but you have to have money to pay for health care idiot. “health care for everyone at anytime” would bankrupt our nation. Plus, it would be abused. People would go to the doctor for no good reason, and it would cost everyone. Idealism is moronic.

  8. Cliff said

    Is it not “possible” to get comprehensive coverage to all or are we all just being a bit too selfish? Why shouldn’t it be possible to cover the costs of health care for everyone at anytime? We’re talking about lives here. This shouldn’t be about costs.

  9. It is always good to see an article about the root of the issue. To many it’s about the uninsured but the real fix is in getting costs under control.

    Friends of mine are in Little Rock, AK as the husband is being treated for Multiple Myeloma. I spoke to his wife over the weekend and she was shocked that the bills she has seen to date are in excess of $160,000. This is without spending a single night in the hospital. A CALPERS PPO will pickup the claim.

    When people tell we we should have comprehensive coverage for all I ask them to explain what they mean. The concept of everything at anytime for everyone is simply not possible.

    More to the point in California if a purchasing pool is run like MediCAL then it will quickly be doomed to failure. Too much of the money available stays in Sacramento. Interesting the SCHIP seems to work fine in California as Healthy Children. Do you think it’s because the State bids it out to (dare I say this) Insurance Companies?

  10. It’s about time the US had a system like the one in the UK.

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