Stanley Feld M.D.,FACP,MACE
After I wrote the article about consumer driven healthcare a Washington lobbyist said to me; “ many people in Washington do not think that the Massachusetts healthcare plan has failed. In fact President Obama and many congressmen think the Massachusetts plan should be the model for the federal government’s healthcare reform plan.”
This is difficult for me to believe. The Massachusetts healthcare reform plan fails all five criteria the Institute of Medicine’s use to define an effective healthcare plan. The plan not only fails all five criteria for healthcare reform, it has encountered obscene cost overruns.
“ The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.”
The Massachusetts healthcare reform plan flunks by all five criteria.
- Universal healthcare coverage : The state still has more than 200,000 citizens without coverage. The number is rising as a result of increasing unemployment.
2 . Continuous coverage: Coverage is not continuous if individuals lose their jobs. The healthcare insurance premiums have risen. Small businesses can not afford to cover employees. It is less expensive to pay the state imposed penalty tax.
3. Affordable for individuals and families: Individuals and families cannot afford coverage.
“For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications. “
4.Affordable to Society : The original budget for the Commonwealth Care subsidized program was $387 million dollars. It almost doubled in the first year to $630 million dollars. The estimated cost in 2009 is $1.3 billion dollars. Massachusetts has already received a federal government bailout of $2 billion dollars for healthcare. These cost increases are not sustainable nor affordable to society.
5.Access to high-quality care for everyone : High deductible plans are cheaper but the deductibles are so high many consumers can not afford care when they are sick. Much of the population is under insured. The goal is to assure affordable healthcare insurance while providing quality care.
If the plan flunks all five Institute of Medicine criteria how can policy makers in Washington think it is a success? They are deceiving themselves and the public. Why bother study the effectiveness of the plan when you can believe in the buzz?
There are other issues that compound the failure. They include local political issues of power.
1. “Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals.
2. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world.
3. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.”
President Obama , please be aware of the unintended consequences of Tom Daschle’s healthcare plan. Throwing money at defective and unsustainable systems will not work. It will fail no matter how much plan is intellectualized by healthcare policy wonks at thirty thousand feet above reality.
Some think the Medicare model meets the Institute of Medicine’s five criteria for healthcare reform. They are convinced Medicare for all is the answer.
They argue;“Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country.
Medicare does satisfy the first three criteria. It insures everyone over 65 regardless of preexisting illness. It provides access to care and not tied to a job.
However, it has not be affordable to every senior. High deductibles, massive copayments and services approved and therefore billable but not covered must be taken into account when deciding on Medicare’s affordability for seniors on a fixed income. Medicare Part D (drug coverage) has failed to be affordable from the onset. The premiums have tripled in the last 2 years.
The cost of Medicare is not affordable to society. If fact bureauocrats have tried to decrease its costs, limit its coverage and limit reimbursement. The Bush administration tried to eliminate Medicare as an entitlement. The increasing cost of Medicare is unsustainable to society. According to the CBO the cost per year will reach 100 trillion dollars in 50 years. Adding the entire population to Medicare will be folly.
The only system that will repair the healthcare system is a system in which consumers control their initial healthcare dollars and is taught to be responsible for their health maintenance. .
President Obama, you should take a hard look at the ideal Medical Savings Account option to control costs and improve the health of America.