Tuesday, June 2, 2009

Nothing New Under the Sun: Massachusetts All Over Again

A law signed in April 2006 in Massachusetts created state funded health care for all of its citizens. There was a deliberate decision to first insure the entire population and then once this was established deal with the cost issue. The idea was to offend no one, keep every constituency happy. Then sometime in the future face the music when costs become unbearable.

False arguments were made such as, universal coverage should in of itself lower costs by preventing chronic disease. This is of course absurd; chronic disease is frequently a product of medical care, keeping people alive who years ago would have died because of their illness. As average life span increases, the chronic disease burden increases and so does the cost. Another false argument was that with insurance for all emergency room visits with their large expense would be drastically reduced. But, that has not happened because of the severe shortage in Massachusetts of primary care physicians. Thus when people become ill their only alternative is the emergency room. There was no provision in the Massachusetts law regarding inappropriate non-beneficial care. However, one only has to look at the Dartmouth Atlas of Health Care to see that a large proportion of care in the state is inappropriate and extremely expensive.

So now Massachusetts has a financial crisis that must be addressed and unlike the federal government cannot print money to cover its costs. Will universal coverage in the state survive? Only time will tell.
The news from Washington is:
1) Medicare is facing insolvency in 2017, if changes are not made.
2) Many working families and our industries are now in financial distress because of the escalating costs of health insurance.
3) There is great variation in the Medicare cost of hospitalization throughout the country without commensurate benefits.

But what of the solutions offered – pabulum disguised as reform that does not address the causes of our excessively expensive health care – Massachusetts revisited!

1)A White House conference including representatives of the health industry that makes vague promises to decrease the increase in administrative costs over the long term. No mention of tackling the problem causing excessive administrative costs at this time.
2)Electronic medical records, a good idea for patient care but not a cost saver (see post titled The Electronic Medical Record: Must it Cost Billions to the Tax Payer).
3)A Comparative Effectiveness Institute, a bad idea that also is not a cost saver (see post titled The Federal Urge to Spend: The Comparative Effectiveness Institute).
4)Enhanced wellness – a vague idea involving dramatic changes in life style of most of our citizens – probably not to be seen in our life time.
5)A change in incentives so that doctors will be encouraged to deliver high quality care. A vague concept that sounds good, but says little.

David Brooks in an op-ed piece in the Wall Street Journal (May 15), titled his piece, Fiscal Suicide Ahead, in essence saying the proposed health care cost savings so far considered by the Administration and Congress maybe good ideas, but will not decrease costs. Thus the funds for the entire Obama agenda will not be available with the result being gross overspending and excessive debt.

By not addressing the fundamental problems within our health care system at this time, and the culture that maintains these very excessive costs (see postings How to Change a Health Care Culture of Excess and Steps to Affordable Universal Coverage), the federal government will find itself in a predicament that makes Massachusetts look reasonable.


Michael Kirsch, M.D. said...

Single-payer advocates should explain the debacle that is occuring in Massachusettes. Initially, patients seeking a primary care physician had to hire private investigators as these physicians were either scare or in hiding. Now, the system is simply running out of money. Why should this Massachusettes "Miracle" be a model for national health care? See MDWhistleblower.blogspot.com

Anonymous said...

Don't be too quick to write off the states.

Connecticut Governor M. Jodi Rell will soon receive on her desk a bill passed overwhelmingly by our state House and Senate called "SustiNet." It sets up a public plan that is more inclusive AND more sustainable than any of the public options being discussed in DC right now. You can learn more about it at www.healthcare4every1.org.

Also, check out Gov. Rell’s new health care reform video at: http://tinyurl.com/kkvyme.

Here in the Nutmeg State, we've got momentum for landmark reform legislation!

Doctor Kenneth Fisher said...

In response to Dr. Kirsch,
I agree with your premise, we need primary care for a health care system to work and we do not have adequate numbers of primary care doctors. That is why one of my suggestions is for specialists to also provide primary care for their patients that do not have a primary care physician.
In Response to iBlog,
Please see my letter to the New York Times April 5, 2009. Without adequate primary care and oversight to control inappropriate non-beneficial care, as in Massachusetts, any attempt at universal coverage will face financial collapse.

Michael Kirsch, M.D. said...

With regard to the inappropriate hospital care, I suggest that billions of dollars of unnecessary care and treatment are occuring in doctors' offices also. I am sure that I am contributing to this excess. Every unnecessary prescription, test, consultation, CAT scan, etc. occurs because a physician orders it. Our profession needs a cultural transformation.