Romney should be proud of Massachusetts health law
It’s been six years since Mitt Romney signed the Massachusetts healthcare reform law. That law was a framework for change, a values statement about what we believe in Massachusetts: that health is a public good and that everyone deserves access to affordable, high-quality healthcare.
Six years after its passage, our experiment in universal healthcare is working, expanding coverage while helping to control costs. Mitt Romney should be proud of the law he signed. As the one responsible for implementing it, I know I am. Here’s why.
More people have health insurance in Massachusetts than anywhere else in the country: 98.1 percent of our total population. Of our children, 99.8 percent are covered. While the number of people without health insurance in America grew from 2006 to 2010, more than 400,000 people in Massachusetts gained coverage.
This isn’t because government took over. Massachusetts healthcare reform, like the national Affordable Care Act, takes a hybrid approach to increasing coverage, encouraging people to get health insurance in the private market and subsidizing the cost for those who can’t afford it. Here again, it is working. More businesses offer their employees private healthcare today than did before the law was signed. The 77 percent of Massachusetts businesses that offer their employees private insurance is well above the national norm.
Most important, people in Massachusetts are healthier and getting better care. Over 90 percent of our residents have a primary care physician, and 4 out of 5 have seen their doctor in the last 12 months. Preventive care is up: More people are receiving cancer screenings, more women are getting prenatal care, and visits to emergency rooms have decreased. After we expanded coverage for smoking cessation programs, 150,000 people stopped smoking, and a recent study by the National Bureau of Economic Research documents improvements in physical health, mental health, functional limitations and joint disorders as a result of the law. While everyone is better off, women, minorities and low-income residents saw the biggest health improvements. I have met individuals whose lives have been saved by the access to good care our model made possible.
Massachusetts healthcare reform has proved to be cost-effective as well. An independent analysis by the Massachusetts Taxpayer Foundation estimated the law was responsible for about a 1 percent increase in net state spending. Spending on our uncompensated care pool – those who receive medically necessary care they can’t afford – is down significantly since the law passed. Today, the Massachusetts Health Care Connector – our version of the “exchange” created by the Affordable Care Act – announced that it will provide private health insurance to more people than ever next year, at an average per-person cost 5 percent lower than last year, the second year in a row of premium decline. Growth in premiums throughout the market has slowed from an average of about 16 percent two years ago to less than 2 percent today.
For these reasons and more, healthcare reform remains popular in Massachusetts. More than 60 percent of our residents support it. They know it is working for them.
Ryan’s budget frames 2012 election around Medicare
This week, House Budget Committee Chairman Paul Ryan released what amounts to the most substantive roadmap for fiscal policy that any Republican is likely to offer in 2012. Many political pundits and policy analysts, especially those on the left, are eager to dig into the details to alert the public about the potential (negative) impacts of a budget that slices off $5 trillion in total federal spending compared with the plan offered by President Obama in February.
Providing 100 pages of budget and policy detail in an election year is considered political suicide by many. Democrats fully intend to use the plan to campaign against Republicans in the fall, hoping to gain an advantage not only in select House or Senate races but also in the presidential contest.
Ryan, though, sees this as the only responsible path forward: So what if his plan won’t get enacted into law this year. Should Ryan’s House colleagues, or the candidates for president, avoid taking a detailed position on our country’s fiscal future? As Ryan explains: “If we simply operate based on political fear, nothing is ever going to get done.”
Keith Hennessey provided a great top-line summary of how Ryan’s budget compares with Obama’s:
- Under the Ryan budget, debt would peak at 77.6 percent of the economy in 2014. Under the President’s budget, debt would peak at 80.4 percent of the economy in that same year.
- The Ryan budget would cause debt to steadily decline to 62.3 percent of GDP by the end of the decade. Under the Obama budget, debt would flatten out by 2018 and end the decade at 76.3 percent of GDP, 14 percentage points higher than under the Ryan budget.
- At the end of 10 years, debt would be declining relative to the economy under the Ryan budget, while it would be flat under the president’s budget.
While most of the Republican candidates for president have signaled support for Ryan’s proposal, Governor Romney’s proposals probably track the closest, particularly in the area of Medicare reform. This is a big deal, since it suggests that the presumptive Republican nominee will be advancing an agenda that also echoes the key policy contrast that Ryan is purposely setting up for November.
For Ryan, Congress not only needs to reign in today’s discretionary spending but it also needs to rise to the challenge of making the hard policy choices that will affect the size and shape of tomorrow’s debt and deficit trajectory. And the number one driver of our long-term debt problem is rising healthcare costs.
It was the Republicans, starting with Reagan, who enacted ‘unfunded tax cuts’ & began running up the current US deficit.
http://advisorperspectives.com/dshort/up dates/Debt-Taxes-and-Politics.php
See how the graph starts rising steeply from 1981, when Reagan introduced ‘supply-side economics’ — the only exception being Clinton, who brought the budget back to surplus & presided over an economic boom.
To this day, G.O.P candidates are pushing ‘tax cuts’. It’s dishonest & un-American to complain about the deficit & the economy, while blocking Democratic efforts to improve it. Remember the public option? That would have done more to bring down costs & provide a cheaper option, than any other recent suggestion.
Republicans attacked & blocked it.
Don’t forget that healthcare is cheaper (half the price) & better in Canada, France, Sweden & half-a-dozen other European countries. Many of them with single-payer or public options.
An unsung victory in healthcare
In 2008, 17 percent of office-based physicians and just 9 percent of hospitals had basic electronic health records (EHRs) and fewer than 10 percent used electronic prescriptions. This doesn’t mean most physicians were Luddites; rather, there were powerful disincentives to their adoption of health IT.
For example: Installing electronic health records required retraining physicians and staff, exacting months of significantly reduced productivity. Technology from different vendors typically did not communicate with each other, so the free flow of information — referral letters, hospital discharge summaries, lab results, X-rays and all the rest — that would make the investment worthwhile was not there. Then there was the network effect: Until a lot of doctors and hospitals were using electronic health records and a lot of vital information was available electronically — even if the various proprietary systems did communicate — it wasn’t worth it. And finally physicians feared that an expensive new EHR system would soon be obsolete, requiring another big capital investment.
On Feb. 17, 2009, President Obama signed the Recovery Act, which contained a number of healthcare provisions, including the Health Information Technology for Economic and Clinical Health Act (HITECH), which nullified these disincentives. HITECH did this by providing physicians payments of up to $44,000 from Medicare and $65,000 from Medicaid — and hospitals getting millions of dollars, with amounts varying based on how many Medicare and Medicaid patients they cared for — to help defray the cost of EHR adoption. Obviously, this is not free money. Physicians and hospitals receive the incentive payments if their EHRs are certified as capable of supporting “meaningful use.” This, in practical terms, means they can be used for e-prescribing, securely exchanging patients’ health information and electronically submitting data on the quality of care. The law also includes a penalty for physicians and hospitals that do not implement EHRs: Their Medicare payments will be reduced beginning in 2015. It also empowers the government to set technology standards regarding interoperability and the secure exchange of health information.
A lot of naysayers carped that this was not an economic stimulus that would help get the country out of a recession, so it didn’t belong in the Recovery Act. Others complained about the myriad requirements necessary for meaningful use. And not a few physicians were resentful, declaring that they would stop practicing rather than adopt EHRs.
It’s now been a year since the administration released the regulations specifying meaningful use and what it takes to be certified — the nuts and bolts of implementing the law. The results have been nothing short of spectacular.
As of December 2011, the use of EHR among office-based physicians has nearly doubled to 34 percent with e-prescribing exceeding 40 percent. Over 41,000 physicians have received more than $575 million in incentive payments. Going electronic will allow physicians to more closely track patients, especially the chronically ill, enabling the seamless exchange of data across multiple physicians, hospitals and other providers. For instance, Delaware is completing a framework for the electronic exchange of patient information among all the state’s hospitals. And the more physicians and hospitals have electronic records, the more effective and useful the exchange of data will be, enhancing patient care, especially in emergencies.
The story is much the same among hospitals: 35 percent have adopted EHRs, and nearly 2,000 of the 4,700 hospitals have, collectively, received more than $2 billion in incentive payments. Every month has surpassed the previous month as measured by the number of physicians and hospitals that have signed up with the government for the EHR program, suggesting that these numbers will continue to rise.
Is it just me, or do conservatives loathe every single law and regulation on the books? As near as I can tell, there is not one they approve of, and they seem to feel that most are advancing the end of civilization. Or does this just apply to anything passed by liberals or Democrats? I would like to see some proposed solutions to anything that did not involve the simplistic idea that getting Obama out of office will make things wonderful.
Wal-Mart will see you now
By Dave Chase The views expressed are his own.
“We don’t have a debt problem. We have a healthcare problem.” Those are the words of Laura Tyson, one of the most respected economists in the world. In Bill Gates’ recent TED talk, he described healthcare as the factor that is devastating state budgets leading to education cuts. Clearly something must to be done now to address this crisis.
With the possible exception of the federal government, no organization is in a better position to reverse healthcare’s hyperinflation than Wal-Mart.
If that sounds crazy, let me explain. As Ezra Klein recently pointed out in a Washington Post graphic, it’s not the age or obesity of the population that is driving healthcare costs. Nor does it have much to do with alcohol or even malpractice costs. Rather, as the many cost comparisons in the presentation below show, we simply pay more for the same items when compared to other countries.
No organization in the world has more prowess than Wal-Mart at negotiating costs with suppliers of products and services. With 1.4 million employees and hundreds of millions of customer visits every month, Wal-Mart’s impact is without parallel. It’s one reason that the Sierra Club partnered with Wal-Mart on its Sustainability Program. In healthcare, Wal-Mart’s $4 prescriptions program has saved their customers billions since the program’s introduction.
Sam’s Stimulus
I don’t see going to Walmart for my primary care but I’m glad they are planning to do it. It should provide a jolt to get the broken healthcare system to fundamentally rethink what they are doing. What exactly was wrong with paying my family doctor directly without insurance middlemen mucking things up? When Walmart brings efficiencies, consumers usually win. If you don’t like them, shop elsewhere. Sounds simple to me.
The government’s waning support of breast cancer?
By Sally Pipes The opinions expressed are her own.
Breast Cancer Awareness month, which wound down last month, appeared to get plenty of government support.
Health and Human Services Secretary Kathleen Sebelius held a teleconference in recognition of national mammography day. She and Thomas Frieden, director of the Centers for Disease Control, touted a new program to promote awareness. The Vice President’s wife, Dr. Jill Biden, spoke about the importance of early detection, and Barack Obama himself, in a Presidential proclamation, said that “we reaffirm our commitment to supporting breast cancer research.”
It’s a sad irony, then, that at the same moment our leaders say they’re working to fight breast cancer — which kills some 40,000 American women a year — the Food and Drug Administration is on the verge of revoking approval of an important treatment.
Once the FDA has authorized a medicine, it seldom withdraws its seal of approval. It approved Avastin to treat breast cancer in 2008. But in July, an FDA advisory panel recommended revoking that authorization.
The FDA won’t make a final decision until December, but only in rare cases does it reject the recommendations of its advisory panel. More than likely, breast cancer sufferers being treated with Avastin, which has been prescribed to some 17,500 patients, will find their lifeline cut off.
The panel concluded that Avastin, which will remain approved to treat other cancers, wasn’t showing enough promise against breast cancer. But we know that in the manufacturer’s crucial phase III trial, nearly 50 percent of patients receiving the medicine saw their tumors shrink — and that Avastin has added years of life for some patients.
a more balanced assessment
http://www.bizjournals.com/sanfrancisco/ blog/2010/10/cancer-network-favors-avast in—mostly.html
Healthcare overhaul: The good news
– Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner. The views expressed are his own. –
After a feisty year of debate, Congress has passed healthcare reform legislation. Once enacted, it will increase the number of Americans with health insurance as well as both the size and scope of government.
And the numbers? Staggering when you consider they are absurdly under-scored. According to Douglas Holtz-Eakin (director of the Congressional Budget Office from 2003 to 2005), if you strip out all the gimmicks and games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion. Even with readjustment, it will make the Social Security trust fund look like Fort Knox.
So here’s the good news — the solution is innovation.
We have to embrace innovative technologies for medical records and prescribing. We need innovative clinical trial designs and molecular diagnostics so that we can develop better, more personalized medicines faster and for far less than the current $1 billion plus delivery charge. We need innovation in access and reimbursement policies that reward speed-to-best-treatment rather than more lower-cost patients per hour.
Will more people have access to health insurance? They will, and that’s a good thing. But, let’s be honest, we’re not talking about erasing the word “uninsured” from the American healthcare dictionary — we’re just redefining what it means.
We have to embrace the fact that we will all pay more in taxes (yes, all of us) eventually. And, ultimately, we will be okay with that. Americans are always willing to do what’s right for their fellow citizens. As Winston Churchill said, “Americans always want to do the right thing — after they have tried everything else.” Even so, many of our fellow Americans will receive less comprehensive healthcare benefits than they are receiving now.
Small businesses with less than 50 workers are smiling after both the jobs and health bills
Three ways the health reform package helps control costs
– David Kendall is senior fellow for health and fiscal policy at Third Way. The views expressed are his own. –
Among the many unfair accusations leveled at the health reform package just passed by the House is that it “does nothing” to control soaring health care costs.
In fact, nothing can be further from the truth.
At the same time that it will provide unprecedented stability in health care coverage to middle-class Americans, health reform will also bring about a quiet—but far-reaching–transformation of how our nation pays for health care. The result will be more efficient, better quality care, along with cost savings estimated by the non-partisan Congressional Budget Office of $138 billion over the next decade.
One way reform will bring about these savings is by reforming the current “fee-for-service” system, where doctors are paid for individual procedures they perform but not for the overall result.
The current system, for example, lets doctors who cause infections through improper hand-washing send more bills to treat it. In effect, doctors are paid more if they make mistakes and fix them than if they get it right the first time. Tens of thousands of medical errors are committed every year, ranging from gross errors such as the amputation of the wrong leg to accidental errors in dosing medication.
Health reform will require hospitals to effectively put a warranty on their care by limiting the payments they get from Medicare or Medicaid if a patient is readmitted to the hospital for what is considered a preventable reason. The result will be fewer medical errors, including fewer preventable re-admissions and fewer patient injuries and deaths—and a reduction in the $17 billion and $29 billion per year that hospitals now spend to fix medical errors.
So–this is going to decrease costs?? Then why has my Ins. just gone UP and Med. Costs went UP…and coverage went DOWN…explain that to me…I work for a living..and the living part is getting worse..meeting NEEDS all the time..not able to get WANTS once in awhile for kids is frustrating..with taxes..TAXES going up..STATE/City’s/Gov./Fed.explain to me where I a WORKER/TAX payer is benefitting..
iPhone app makes doctors iRate
– Ford Vox is a medical journalist and a physician. The opinions expressed are his own. –
That iPhone 3G you’re packing comes with a truly killer app: one guaranteed to hurt your relationship with your doctor if you use it to secretly tape your appointments.
That’s what happened recently inside one Washington state hospital, according to the irate physician, who complained about his experience to colleagues on Sermo, an MD-exclusive social network.
Dr. Anonymous examined a woman recovering from surgery to see if she needed rehabilitation. He found signs his new patient might not handle all the therapy that goes along with a spot in a rehab hospital. After discussing her choices for about 15 minutes, Dr. Anonymous discovered that the patient’s daughter’s iPhone displayed a metering bar moving as he spoke. “I had no idea I was being recorded,” he wrote.
Fellow doctors chimed in with near unanimity: call the hospital’s risk management officer, call your malpractice carrier, and fire that patient! While it’s a rare event, doctors can “fire” any patient from their care after supplying 30 days notice and a referral.
“Other than having an attorney in the room taking notes, I don’t see any bigger red flag than this” for an impending lawsuit, wrote an Ohio-based obstetrician-gynecologist.
Shocked, Dr. Anonymous didn’t say anything to the patient’s daughter, but knowing he was being recorded made him less open for the remainder of the consultation, and afterward he notified his malpractice insurance company.
Open recording of healthcare providers will result in one thing. Worse health care that is more expensive.
You are going to have doctors who are going to go by the book on everything. Only going to give you the FDA, standard treatment. Start low, go slow etc etc and order every freaking test known to man “just to be on the safe side ma’am.”
Whoever said there is no tort reform needed is crazy. Lawyers run this country. I am a malpractice lawyer and life is good. The public is stupid and easily fooled. Now that I am ready to retire, I am completely behind tort reform because otherwise this country will collapse under the weight of healthcare costs. Or you are going to see the best doctors only treat the richest…see concierge care.
A faulty prescription for reform
– Dr. Steffie Woolhandler is a co-founder of Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance. She is a professor of medicine at Harvard Medical School and co-director of the school’s General Internal Medicine Fellowship program. The views expressed are her own. —
President Obama, at today’s summit and in his proposal earlier this week, has embraced a deeply-flawed bill – the Senate bill – as his model for reform.
That bill would leave about 24 million people uninsured in the year 2019, according to the Congressional Budget Office. Leaving 24 million people without health insurance is neither “universal care” nor even serious reform. As my research team has recently shown, that 24 million uninsured people would translate into about 24,000 unnecessary deaths annually. As a doctor, I find that prospect completely unacceptable.
Sen. Harry Reid, in his opening remarks at the summit, cited our study about 45,000 deaths annually due to lack of insurance (with about 45 million currently uninsured). He also cited another recent study we published showing that 62 percent of bankruptcies are linked to medical bills and illness, and that three-quarters of those bankrupted had health insurance when they first got sick. But when it comes to a remedy, the senator – and the president, I regret to say – offer the wrong prescription.
Their proposal is based on handing over $440 billion in taxpayers’ money to the private health insurance industry, the cause of the problem in the first place. Their rationale is to subsidize purchase of the insurers’ shoddy policies, which are riddled with gaps like ever-increasing co-pays, deductibles and uncovered services. Decades of experience show that the private insurance industry can neither control health care costs, nor give American families the health coverage they need. Many states already regulate insurance premiums and coverage, so merely regulating private insurers is not the solution. Moreover, the Senate plan to send $440 billion into the coffers of the profit-driven insurance industry will give them even more financial and political power to block future reform.
Once the president decided to allow the private insurers to continue to run our health care system, he effectively blocked any prospects for a reform that was comprehensive, universal and affordable. And he immediately faced a series of unpalatable choices in order to raise money to pay for reform, including proposals like mandating that uninsured families pay thousands of dollars for skimpy private coverage, cutting back Medicare coverage and imposing a new excise tax on the health benefits of workers.
What we need is a Medicare-for-All approach, which makes universal health care affordable because it saves about $400 billion in administrative costs every year. It would eliminate the wasteful paperwork and bureaucracy that the insurers impose on our health system and you use those savings to cover the uninsured, and to plug the gaps in coverage for people who now have insurance.
No one is talking about providers not getting paid – doctors, nurse practitioners, dentists, and clinics and hospitals will get more payments with a Medicare for All system than the one we have now where millions of people have to pay out of pocket and after layoffs can’t and must default or go into credit card debt or decide to die. What is this rubbish about Canadians en masse wanting to have our system? That is not true. Yes, there is a wait for specialty services, but there is a wait here as well. And for many people the wait is here permanent and fatal due to lack of ability to pay.
Your health plan’s Toyota complex
– Ford Vox is a medical journalist and a physician. The opinions expressed are his own.–
A trade group by the name of America’s Health Insurance Plans began the week with oddly revealing rhetoric against a key proposal under debate at the health care summit today – controlling insurance premium hikes. Obama’s proposal “would be like capping the prices auto makers can charge consumers, but letting the steel, rubber, and technology manufacturers charge the auto makers whatever they want,” said Karen Ignagni, AHIP’s president.
Ignagni’s analogy shifted blame onto doctors and hospitals — the rubber and whatnot — but her analogy is apt in one way – we’ve got to pay attention to where the rubber hits the road. Relying on face-to-face relationships and earned trust, doctors are better poised to control costs than any federal agency or insurance company. Family practice doctors, who wield the referral, are the key to reigning in the excessive outpatient specialist care that accounts of much of the waste in American medicine. But they need some skin in the game.
University of Manchester researchers followed UK private practices and chronicled the power shifts that occurred after the roll out of the 2004 National Health Service contract, which was designed to allow family doctors to reap financial rewards by proving they’re keeping their populations healthy. U.S. legislation can similarly require that whatever fund is paying the bill (private, Medicaid or Medicare) hand over more control to the doctors on the front lines by designating more administrative responsibilities, and the dollars that go with them, to physician practices.
The National Committee for Quality Assurance has already laid some foundations, getting primary care physician organizations on board with the concept of the medical home, so that primary doctors will adopt outcome measures and accepted processes that are known markers of quality and that keep costs down.
Now is the time to give this program teeth. Let’s legislate such programs and mandate that significantly more insurance dollars (government and private) go where the rubber hits the road.
I agree. Companies will always try to maximize profit and growth. Only competition and controls (specifications and controls on quality) limit what these companies do. It is clear that the health care industry cannot govern itelf. Also this is true for the banking industry and the auto industry. Might even work for the trial lawyers to have some rules.
I think the real issue is that ‘We the people’ will get the ‘affordable’ part and the politicians will get the ‘high-quality’ part.
If it was *really* high quality, why won’t the politicians be using it also and why is there an ‘exception’ list with many companies, unions, and others ‘opting out’?