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March 13, 2008

Coverage up, cost down? Pie-in-the-sky or down-to-earth? Federal or State?

A few observations on recent pieces of the conversation on health care reform at the state and federal levels:

Sen. Ron Wyden continues to push his health reform legislation.  He was hawking it last week at the AHIP meeting.  (Matt Holt has posted the full text of Wyden's remarks.) 

About a year ago, I wrote about how Wyden's plan (or John Edwards' plan -- remember him?) would interact with the Massachusetts health care coverage law at CommonHealth.  At its core, Wyden's plan would eliminate the employment-health insurance connection and require employers to pay employees some extra bucks buy their own insurance.  It would cut some waste and promote preventive care.  All that, and it's predicted (by Wyden) to trim less than 1% off the current inflation rate.

Last week, Massachusetts Senate President Therese Murray filed legislation aimed largely at ensuring that the second leg of Massachusetts' three-legged stool of health care reform -- cost containment -- gets a fair shake, though  the talking points for her testimony at yesterday's committee hearing on the health care bill demonstrate the breadth of the bill:  It ranges from requiring public hearings for any health insurance rate hike of over 7%, to the much-discussed ban on physicians accepting gifts, to allocating funds (though not enough) to rolling out EHR systems and CPOE systems -- both ultimate cost-savers, to taking a crack at reducing the PCP shortage through outreach and loan forgiveness. 

See today's Boston Globe's coverage of the hearing on the health care bill for more information, including snippets from the testimony of two former health care committee chairmen:

"The big bogeyman . . . is payment system reform," said Senator Mark Montigny, a New Bedford Democrat, at a hearing on Murray's bill and another proposed by health insurers. The state needs to take on "the cozy relationship" between the state's largest hospital system, Partners HealthCare, and its largest insurer, Blue Cross-Blue Shield, Montigny said.

John McDonough, executive director of Health Care for All and a former House healthcare committee chairman, said large healthcare providers, particularly hospitals, have driven up the costs through secret negotiations with insurers. He proposed that the state seek federal approval to impose a system in which payments would be made based on the service provided and not on who was shelling out the money or how much clout the provider had.

The payor community had its own bill before the committee in Boston this week.

Payors, and the other parties to this inelegant conglomeration we call the health care system, should be paying attention to the Boston Globe op-ed piece penned by Joe Dorsey and Don Berwick a couple of weeks ago, wherein they dare to mention the "dirty words" of "managed care" and "capitation."  Their point: there are lessons to be learned from "good" managed care systems such as the Harvard Community Health Plan system they practiced in as clinicians that can lead to better care at lower cost.

They may be jumping ahead.  Back to the three-legged stool: Once Massachusetts addresses coverage and cost, the system needs to address quality of care.

-- David Harlow

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