State health care reform has had some unexpected results

[BostonWu]

Some insurers say the Massachusetts law mandating coverage has added to the cost burdens on the health system. At least initially, they said, it encouraged newly enrolled members to flood the offices of primary care physicians and specialists to receive physicals and other exams.
A special state commission studying changes to the payment system has recommended insurers scrap their practice of paying doctors and hospitals fees for individual visits or procedures and instead offer a set amount to cover patients’ care for a year.

The higher insurance costs undermine a key tenet of the state’s landmark health care law passed two years ago, as well as President Obama’s effort to overhaul health care. In addition to mandating insurance for most residents, the Massachusetts bill sought to rein in health care costs. With Washington looking to the Massachusetts experience, fears about higher costs have become a stumbling block to passing a national health care bill.

http://www.boston.com/business/healthcare/articles/2009/09/16/health_insurers_plan_10_rise_in_rates/

If costs are blowing up in Mass. then how can anyone expect it to work on a national level? Anytime you give the general public blank checks then they’re going to cash them.

And why aren’t we hearing about this in the media? :banghead: :banghead::banghead:

[ShockBand]

Your statement about how doctors, hospitals, etc, are paid is one you tend to hear little about but from what I've gleaned may be the real lynch pin in why costs keep mushrooming.

On NPR last night, one economist who says the public option itself won't control costs stated that the problem lies in the fact that the providers get paid more when they produce more volume, i.e. tests, procedures, and so on. That notion of a set amount for a patients primary physician care (essentially a subscription) I think is one worth further exploration. I read an article this summer that showed one of the reasons the Mayo Clinic was able to keep their costs in check was because all their doctors are paid a flat annual salary, not by number of procedures done.

Food for thought, which I wish we were getting more of in the health care debate instead of ideological posturing over socialism vs. free market. All the shouting and finger pointing means its very tough to get through the chatter and noise and glean good info about the real core issues as to why health care costs are spiraling up so bad.

JMHO.

[SubGod22]

Because the media, for the most part, doesn't want to do anything that will make this administration and/or Congress look bad. The good news is the administration and Congress are still doing a good job of that without the media coverage.

[Maggie]

Boston - that is why I found your governor’s editorial in the WSJ the other day, shall we say, a bit disingenuous. He writes, in part:

Opponents of reform claim that the Massachusetts experiment is too costly. They are wrong. State estimates and independent analysis from the Massachusetts Taxpayers Foundation concur that health-care reform has only added moderate incremental costs to the state budget. As more of our residents have become insured, there has been a decrease in demand for costly emergency-room care. Even in the midst of the current economic downturn, our state budget was balanced. (emphasis added)

Massachusetts Is a Health-Reform Model

Okay but those “moderate incremental costs” according to the same Massacheusetts Taxpayers Foundation, as quoted in the WSJ just the day before, appear to work out like this:

In Massachusetts, rising health-care costs, already among the highest in the country, threaten the insurance mandate's long-term viability. The state's costs to expand coverage have swelled nearly 70% to an expected $1.75 billion in fiscal 2010 from a base of $1.04 billion in 2006, about half of which is supported by federal funds, according to the Massachusetts Taxpayers Foundation, a nonprofit policy research group. (emphasis added)

Mandated Health Insurance Squeezes Those in the Middle

Your governor ignores the fact, as the article you link points out, that premiums in Massachusetts will jump by at least 7% - I think that is about double the national average. And as far as the balancing the budget – is that not a legal requirement in Massachusetts? People I work with in Massachusetts advised, and maybe they are wrong, that the budget was balanced by a substantial increase in taxes – including the sales tax.

Sorry, Boston – it doesn’t appear that Massachusetts is proving to be an effective model.

[BostonWu]

Sorry, Boston – it doesn’t appear that Massachusetts is proving to be an effective model.

No arguments from me

[Maggie]

Sorry, Boston – it doesn’t appear that Massachusetts is proving to be an effective model.

No arguments from me

I know.

[RoyalShock]

On another forum I frequent there was a discussion on why costs are so high. One person in particular made a lot of sense. I'll try to summarize.

Basically, the system is currently set up in such a way that no one is in a position where they have to care about the costs.

Insurance company - They don't care. They can just raise premiums.

Employers - They get a tax benefit (I'm not sure how true this is. I'm not saying it is or isn't. I just don't know.)

Employees - Their costs are largely capped via co-pays and benefits.

Doctors/Providers - They negotiate with the insurance companies, who can just pass costs on to employers.

So what you have is a system where the cycle creates sort of a positive feedback loop.


Here are some of my random thoughts on this.

- HSA's are a good start to at least get people looking at what they are paying and get used to the idea of insuring against more catastrophic care instead of preventative and minor care.

- Most primary care physicians are employed by clinics. So I'm assuming they get a salary and the clinic benefits from lots of visits, tests, etc. I think we need to move toward a cash-only option for doctor visits. Less paperwork (no insurance filings), lower costs and clinics would have to compete.

- Malpractice reform. As long as doctors feel like they may get sued if every possibly relevant test isn't performed, there will continue to order unnecessary tests. Doctors need to better inform patients so that they can be more involved in the decision making. Easier said than done, I know.

- Remove or redesign the tax incentive for employers.

I'm sure more can be done, but at least those things would create an incentive against rising costs and prices.

[BostonWu]

Royal - That all sounds very familiar. The program I watched pointed out that the cost for many elective procedures (Lasik was an example) have gone down over the years. The reason being that when patients have to foot the bill they actually shop around and negotiate the best price.

[SB Shock]

I read that in Mass. people have found out is cheaper to pay the government mandated fine for not participating in health insurance and then buying the health insurance if a situation arises where they need it.

There seems to be so much low hanging fruit health insurance reform that congress could do to improve the health insurance situation than trying to enact a huge social program.