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The Romney Bipartisan Universal Healthcare Plan Is Being Revised Already! Massachusetts panel approves changes to subsidized residents health plan

Stanley Feld M.D.,FACP,MACE

It is worth spending some more time on the ill conceived bipartisan mandatory universal healthcare plan of former Governor Romney.

As I pointed out, I believe the original bill was well intended. It was supposed to be universal insurance coverage without a single party payer. The market was supposed to self regulate premiums while giving patients choice. The defect in the plan was clear to many. It catered the wrong stakeholders’ vested interests without reforming the healthcare system. One can not expect real improvement by patching the present healthcare system in favor of the healthcare insurance industry. I suspect Governor Romney pushed this plan to gain national visibility in his planned run for the presidency.

Today the Massachusetts legislature started changing the provisions of the original universal coverage bill. The changes represent another complicated mistake that is destined to fail.

“Striving to hold down costs to taxpayers, a state panel yesterday approved a range of changes for next year for the rapidly growing subsidized health insurance program. The changes will probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay.”

Please note who the victims of the payment cuts are; the physicians and the patients. The healthcare insurance industry is challenged by the state to simply reduce their planned increases from 14% to 9-11% next year.

“The goal “is to make this great healthcare reform effort sustainable,” said Leslie Kirwan, secretary of administration and finance and chairwoman of the Commonwealth Health Insurance Connector Authority, which is overseeing the insurance initiative.”

Leslie Kirwan seems to be the purveyor of political babble for the state of Massachusetts as you can read in my previous discussion of the Romney Plan.

“For the subsidized plan, called Commonwealth Care, the authority’s staff has suggested that costs per member could rise as much as 14 percent next year, if there were no changes.”
“The bid specifications will direct the four insurers that administer Commonwealth Care to cut payments to healthcare providers by 3 to 5 percent.”

Without real price transparency by the healthcare insurance companies effective reductions in premiums will not occur. Competition among insurance companies to become more efficient is not stimulated.

All the stakeholders must participate in real price transparency if we are going to have a chance to repair the healthcare system.

“There’s no justification to be paying more than Medicaid rates,” said Patrick Holland, the authority’s chief financial officer.”

Patrick Holland ignores the fact that the federal government is having problems forcing physicians to see Medicaid patients. Medicaid reimbursement is below physicians’ costs. They can not afford to take care of Medicaid patients at the present level of reimbursement and their present level of inefficiency. The reduction in reimbursement below the cost of production of services without incentives will not solve anything. Real healthcare reform along with decrease in healthcare cost will occur when then is a full court press on preventing complications of chronic disease.

Examples of ineffective chronic disease management appear monthly in the medical literature. All stakeholders are to blame. The incentives for chronic disease management do not exist. A most recent example appeared in the December 2007 issue of the Archives of Internal Medicine. The article is entitled “Inadequate Control of Hypertension in US Adults with Cardiovascular Disease Co morbidities in 2003-2004.” Only 49.3% of patients were within 20 mm Hg of the goal of therapy. Only 69% of patients received any treatment. Patient compliance as well as the ineffective practice of evidence medicine is always at the root of the problem. The lack of reimbursement needed for physicians to develop the necessary systems of care is usually the cause of ineffective care.

“In addition, the board voted to eliminate one part of the program that has been the most expensive per member. That program had allowed patients to pay a higher monthly premium in order to incur lower fees each time they sought care. But the option drew the sickest and oldest patients and was twice as expensive for the state as a plan with lower premiums. The approximately 3,500 patients in that plan will have to shift into an option under which they pay more of the cost per visit.”

By shifting the burden of payment to the patients creating higher deductibles for less coverage will result is forcing patients not to buy insurance. They simply can not afford to buy insurance. The state would be making criminals out of sick patients because the Massachusetts law makes it mandatory to have insurance.
The way to avoid this imbalance and problem is with a subsided Ideal Medical Savings Account.

When are politicians going to see the obvious? Constructive change will occur only when the consumer knows what to demand and how to demand it. Consumers will get results when politicians’ political future is threatened. Only then will the politicians refuse to be influenced by corporate vested interest.

  • KGilbert

    “That program had allowed patients to pay a higher monthly premium in order to incur lower fees each time they sought care.”
    Even more insidious is that now those patients have a disincentive to seek the short-term preventive care that may save them from future expensive hospital time. This is the same problem that HSA’s run into – it is too easy to forego preventive care when there is a high deductible.

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