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November 11, 2005

Baker's half-dozen

Earlier today, David did a terrific job of running down the six health care op-eds in the Globe today.  I have nothing to add to David's takedown of the hapless Christopher Anderson, except to agree that Anderson's column was a factual and moral belly-flop. Mr. Anderson gives us the choice of thinking he's either a. ignorant or b. mendacious. I don't like making choices like that.

Charlie Baker's column doesn't address the hot-button issues like mandates, but he really gets to the heart of the issue: Why is health care so insanely expensive? The fact is that any health care plan would be more palatable if we knew it wouldn't cost us, well, an arm and a leg going forward.

Markets depend on good information to function efficiently, and most patients, insurers, and hospitals -- don't have good, transparent information by which to make decisions. And indeed, some stakeholders (PhRMA says hi) are actually opposed to good information in the marketplace. Who are the best hospitals? Which procedures are useful, and which are not? Which drugs? and so on. Massachusetts probably has more health care brainpower per capita than any state in the union; if the Senate's proposed Health Care Quality Board is a world-class health care evaluation/investigation machine, we could be leading the country toward lower health care costs. This should not be an afterthought: the state government is the perfect -- maybe the only -- body to supply such information to the public.

I also have not heard about the fate of the re-insurance program contemplated in Travaglini's original plan, and the MassACT ballot initiative. This would introduce cost-sharing between the state and insurers for the most expensive cases. Now, on one hand, this would obviously cost the state money. On the other hand, this might accomplish two goals: 1. It would give insurers more "cost certainty", allowing them to lower premiums, and 2. given proper oversight, the state might also be able to use its buying power to keep costs low, essentially becoming an 800-pound market gorilla -- if not a "single-payer" -- for very expensive cases. If this combination ends up with lower premiums outstripping somewhat higher state revenues (even -- gasp -- higher taxes), then it's a net win for consumers.

Baker's other proposal, that health care premiums for individuals and small groups should be tax-deductible, is only fair. A no-brainer.

In general, I'm extremely encouraged by all the terrific, substantive commentary on the Globe's op-ed page, which today (mostly) showed a high level of literacy, passion, and moral clarity about the issue. Of course, we've seen that here in the comments of this blog, too. I'm hopeful that the more people know about the issues, the better the eventual legislative product will be.

Posted by Charley on the MTA at 06:30 PM in Health Care, Massachusetts | Permalink


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I absolutely agree that the premiums should be deductible for individuals, and I haven't seen this in any legislation. Sadly, Massachusetts only has power to affect the state income tax deductibility, because the Feds take a big bite.

Posted by: Abby | Nov 11, 2005 8:05:24 PM

In line with Mr. Bakers' suggestion that more information would lead to better decision-making, has anyone read the Massachusetts Inspector General's report on the Uncompensated Care Pool and the outright theft Massachusetts hospitals are engaged in while charging off health care to the pool?

The report can be found on the IG's website: http://www.mass.gov/ig/publ/poolrpt.pdf

Three items of note: 1) hospitals were granted anonymity in return for providing truthful information; 2) nowhere in the report is there a “bottom line” figure as to the amount of questionable charges to the fund, although there are many documented instances of hospitals ripping off the state; and 3) the hospitals that engage in the outrageous practice of stealing from the Commonwealth are not held accountable – the state is to blame because of lack of oversight and low reimbursement rates for Medicaid payments.

Someone from the offending hospitals should go to jail. Taking money because its easy is the mark of immorality – for the IG to justify this practice as he does in the report is dereliction of his duty.

Posted by: Jack Ryan | Nov 12, 2005 7:28:13 AM

JR: I downloaded the report. Tell me chapter and verse where the hospital fraud is occurring. Thanks.

Posted by: Charley on the MTA | Nov 12, 2005 1:44:17 PM

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