Stanley Feld M.D.,FACP,MACE
I predicted the bipartisan Romney universal healthcare plan for Massachusetts would fail. The reason is simple. The rules of the game were not changed for the insurance industry, the hospital systems and the physicians. The reason this important idea cannot work is because the program was superimposed on the rules of a broken healthcare system.
“The state’s new subsidized health insurance program will cost “significantly” more than the $869 million Governor Deval Patrick proposed in his 2009 budget just two months ago, the state’s top financial official said yesterday, after insurers were granted an increase of about 10 percent.”
As long as the insurance industry controls the pricing without price transparency the price is going to escalate. If hospitals and doctors are not competing in a price transparent market place, prices will escalate. As long as patients are not responsible for their healthcare dollar there will not be provider competition.
“Officials are scrambling for alternatives after the four healthcare insurance companies providing subsidized insurance under the state’s universal health care law offered bids for continued coverage that were far higher than expected.”
“To close the gap, the Patrick administration has asked insurers, hospitals, healthcare advocates, and business leaders to propose ways to cut costs and raise revenue.”
Notice the group missing from the discussions. Physicians are missing from the table. Physicians are the providers that control healthcare costs. Physicians should contribute to a discussion on how to control costs. Why has no one thought of asking physicians to contribute to the discussion? Perhaps physicians as the non contributing scapegoat is required?
“Leslie Kirwan, secretary of administration and finance, declined yesterday to discuss specifics of the proposals or the size of the budget gap, but said that without changes, the state doesn’t expect “to be able to live within” the proposed budget.”
You may recall that Leslie Kirwan, chairperson of the Commonwealth Health Insurance Connector, said 4 months ago’ “It’s too early to make any departure from the health reform plan,” “We will follow the trends and adjust, if needed.” http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/12/romneys-univers.html
“To partly offset the increased costs, the panel yesterday also voted to raise premiums by 10 percent for some of the 176,000 people enrolled in Commonwealth Care, and to increase copayments for many more. Starting July 1, the lowest premiums will range from $39 to $116 per month.”
If Massachusetts raises healthcare premiums and increases the healthcare copayment many more people will not be able to afford the mandated insurance. The state has already exempted 30,000 people from the mandate to date.
“The budget figure of $869 million already was significantly higher than projected by legislative architects of the plan because of the enrollment boom.”
The state budgeted $472 million in 2007 for the subsidized program, based on enrollment estimates made last winter. Commonwealth Care provides comprehensive insurance to people without access to work-based coverage who earn less than 300 percent of the federal poverty level, or about $31,000 for an individual. This represents an 84% increase and is not close to the insurance industry bids.
“In order to make up some of the difference Leslie Kirwan has shifted some of the money from the $448 million Health Care Safety Net Trust Fund, which pays for care at hospitals and health centers for uninsured patients.”
Officials at many so-called safety net hospitals said that as the new system – which requires all residents to buy health insurance – phases out payments for free care provided to the uninsured, hospitals are facing budget shortfalls and have been forced to cut back on investing in new equipment.
The Romney plan was suppose to be the new hope for a free market healthcare economy. Hillary Clinton’s healthcare plan is similar. However, I believe she knows her healthcare plan will fail. The nation would then be presented with her only alternative, a government run single party payer. In other words the politically incorrect term “socialized medicine” is the only remaining alternative.
No one has thought of giving patients responsibility for their care and ownership of their healthcare dollar. The ideal medical savings account can motivate people to be responsible for their health, their use of the healthcare system and be diligent in their use of their own healthcare dollar.