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Healthcare Leaders In Massachusetts Told To Rein In Costs: Wake Up America!


Stanley Feld M.D.,FACP,MACE

It was obvious to me at the onset that the Romney Massachusetts universal healthcare plan would fail. The healthcare insurance industry has remained in control of the healthcare dollars. The state of Massachusetts, rather than the individuals, would become victim to the rising costs. There was no evidence in the Romney plan that the quality of medical care would increase. The plan was not designed to provide incentives to improve the behavior, patients or hospitals. Massachusetts has already received an 8 billion dollar federal bailout and is seeking an additional 2 billion dollars to stay afloat.

“Governor Deval Patrick yesterday asked the state’s most prominent hospital and health insurance leaders to take quick action to hold down rapidly rising healthcare costs, suggesting that if they did not take steps on their own, they might face new government regulation.”

The state did not alter the healthcare insurance industry’s control of the healthcare dollar in the healthcare system. It generated more insured patients for the healthcare insurance industry. It did not lower the premiums as predicted. The premiums continue to increase. A lack of real price transparency is the reason for this. The state’s universal healthcare plan did not alter patients’ or physicians’ behavior. It lacks patients’, physicians’ and hospital systems’ incentives to change behavior. The Massachusetts plan provides a guarantee for universal coverage but did not improve coverage, or quality or decrease costs.

“Governor Patrick said he is considering holding hearings on health insurance premiums and the primary driver of premium increases – the rates hospitals charge insurers for members’ medical care.”

The governor knows exactly who the primary driver of the costs is. It is the healthcare insurance industry with hospital system collusion. However, he will never be able to prove it without a requirement for real price transparency.

" “ Insurance executives at a meeting said they would welcome such an investigation", according to Charles D. Baker, chief executive of Harvard Pilgrim Health Care, the state’s second-largest health insurer.”

The inspector general (Mr. Sullivan) asked the healthcare insurance executives to refrain from signing new contracts that cover patient care beyond this year until the government has time to consider potential reform measures.

Mr. Sullivan singled out the largest private contract in Massachusetts, the state’s dominant provider, Partners HealthCare, and its largest insurer, Blue Cross and Blue Shield of Massachusetts. The Boston Globe has had multiple stories exposing the abuse to the state and patients by these providers.

“The two agreed last summer to a multiyear contract that calls for annual rate increases of about 5 to 6 percent. Spokesmen for Partners and Blue Cross said yesterday the agreement was final.”

Got cha, tough luck.

The state of Massachusetts response has been to set up a reform payment commission. The commission will examine alternatives to the traditional payment model in healthcare. In Massachusetts the large hospital systems hire most physicians and pay a salary. Physicians have little control over their charges and salaries. I suspect the hospital systems are profiting from physicians intellectual property.

Partner’s healthcare executives and healthcare insurance executives are trying to distract the state from the real issue which is inflated charges.

“ Many insurance executives and healthcare reformers argue that providers should be paid for healthy outcomes, not as they are now – based on the number of tests and procedures they perform on patients.”

“Dr. James J. Mongan, chief executive of Partners, said Patrick "understands [healthcare costs] are national issues, but the state of Massachusetts showed it could lead on national issues with [healthcare] coverage and it’s going to try and lead on national issues with costs."

This rhetoric has not fooled Governor Patrick. However, he seems to be powerless to do anything about it because Partners and Blue Cross control his work force.

“Governor Patrick "made clear that this is sort of a today issue, not a tomorrow issue.”

A state sponsored Spotlight team reported a deal made by Partners and Blue Cross in 2000. Blue Cross would pay for services of Brigham and Women’s and Mass General Hospital (Partners) in exchange Partners would insist on receiving payments from other insurers that were at least equal.

“Healthcare costs have risen dramatically since that time.” Healthcare coverage has also decreased

Tufts Medical Center announced it would stop accepting Blue cross insurance company patients because Blue Cross is paying Tufts 32% less than they are paying Mass General and the Brigham.

“Blue Cross says demands for higher payments by Tufts would increase healthcare costs.”

The state of Massachusetts wanted to do the right thing (universal coverage). It became the victim rather than the cure. In the words of Yogi Berra it is “Deja vue” all over again.

Please listen carefully to Tom Daschle’s proposals for healthcare reform. It is similar to the failing Massachusetts plan.

Wake Up America!!

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