Summary of health care outcomes: does Massachusetts lead the nation?

The recent assessment of the Massachusetts health care reform, released April 12 by the Blue Cross Blue Shield of Massachusetts Foundation is a quick read and well worth perusing by people outside the state. Because Massachusetts anticipated much of the US health care reform effort, this report gives us a glimpse of what can happen in the country as a whole when the provisions of the federal law fully take effect.

There’s lots of good news: nearly everyone in the state has some insurance now, fewer people report “significant out-of-pocket health expenses,” and the bill is popular. It is supported by nearly all physicians, most employers, and two-thirds of state residents as a whole.

The downside, of course, is the cost. More people have trouble paying for care, which seems to clash with the statistic on lower out-of-pocket expenses. The culprit is probably the rise in premiums and the backing off of employers, who are paying for less of the cost of their plans. And I refuse to blame rising costs on the health care bill; it’s a worldwide phenomenon.

Everybody in the state knows very well that costs have to be attacked. The governor drew a line in the sand by denying requests for high premium increases from the insurance companies. Blue Cross Blue Shield itself is trying a new system similar to the Accountable Care Organization model being widely touted. I am a member of Greater Boston Interfaith Organization, which is planning a campaign around costs as its next phase of political action.

It was a relief to read about some negative predictions that didn’t happen. Employers for the most part did not abandon their own health plans and throw their workers into state plans. Most uninsured did not pay the fine and refuse to join a plan; they signed up in droves.

As another nice observation, the study found that racial and ethnic disparities in access to health care have largely disappeared in Massachusetts since the reform.

Political teapots are whistling on the left and right over the recent vote by the Massachusetts House of Representatives to put municipal workers in the pool run by the state for state employees (the Group Insurance Commission). I won’t delve into politics on the Radar site, and certainly not the “Wisconsin showdown” over collective bargaining. But I will list a few facts that need to be kept in light, after talking to a number of progressives who support both health care for all and strong unions.

  • When it comes to health care plans, bigger is better. Because it contains so many workers, the GIC is in an excellent bargaining position in relation to insurers and health care providers. In contrast, Massachusetts towns are hardly in a better position than small employers. So they’re desperate to combine their workers into a bigger pool. The main argument against joining is that, the more people combine into big pools and cut costs, the bigger is the burden on small employers and the self-insured. Some people follow this logic to demand a single-payer system, but I would just prefer to see more efficiency and less waste in the health care system.

  • Knowing that they could avoid cuts (including cuts in union jobs) by joining a bigger pool, towns have been feverishly negotiating for years with their unions to join the GIC, with few successes.

  • Joining a large pool would save so much money that the cities could devote extra money to filling any gap left by GIC coverage and still save a bundle.

To reiterate: we have to get costs down by cutting down on waste. Most providers in Massachusetts have electronic health record systems, putting us way ahead of most US states. But that’s just a start. Efficiency wasn’t built in.

Luckily, I’ve attended health care meetings where leaders in Massachusetts suggest that we can cut costs, even as a single and relatively small state. Besides the formation of ACOs, we can press doctors to institute measures that improve care and reduce mistakes. We can also educate the public to accept lower-cost care. They have to learn three big lessons:

  • A world-famous teaching hospital is not always better than a community hospital for a given procedure.
  • You don’t have to see a specialist for every condition.
  • You don’t need the newest medicines, machinery, and procedures.

Will the rest of this country follow Massachusetts to near-universal coverage and the benefits seen in the Blue Cross study? There are notable differences. Massachusetts started with a higher degree of insurance coverage than the rest of the country. We clearly offer some astonishing medical care (although the big-name institutions don’t always live up to their reputations). We have a relatively highly educated population, and population density makes it easier to provide doctors to everybody. But we still suffer from many of the same problems as health care in other parts of the US. So it will be worth comparing our experience to experiments in other states.

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