Another View: In Massachusetts, We Expanded Access, Then Tackled Costs.

 

Saturday, Aug 01,2009, 11:14:29 AM   Click:

We are at an inflection point in the long struggle for health reform. We have been here before: President Truman proposed a disease for all, President Nixon employer coverage mandate, President Clinton and a deep reform that goes nowhere.

Meanwhile, health care has increased for a sixth of our economy and the uninsured to a sixth of our population. Let us not add President Obama to the list of defeats. As if the reforms to cover 50 million uninsured are not hard enough, he also wants to tame the beast of medical inflation. Having failed for six decades to help the uninsured, most of whom are working poor, some held their coverage of the hostage-control costs for all Americans.

Massachusetts is doing comprehensive health reform, but we took a different tack. Our reforms of 2006 have covered all but 2.6%. Jaclyn Michalos is just one of our 430,000 newly insured. A cancer survivor, she will tell you of the many lives saved because Massachusetts acted. We did not hold Jaclyn hostage to first controlling costs.

Three years later, the state is tackling cost containment. Legislative recommendations from a special commission seek nothing less than to transform the way all insurance pays doctors and hospitals -- for quality, not quantity, of care. Most experts agree and even the hospitals, insurers and doctors on the special commission voted for it.

But make no mistake, real cost reform requires a tectonic shift. Instead of paying fees for every procedure and test, including repeat tests, clinicians would work within a budget to care for their patients more efficiently. To do this right, doctors must transform their practices, and patients will also experience change. For example, physicians will e-mail and telephone their patients for follow-up, rather than make them spend two hours getting to and from a 10-minute, billable appointment.


In Hawaii, the doctors at Kaiser Permanente, one of the models that President Obama cites, now do 25% of their patient encounters this way, but first they had to build and learn to use a shared electronic medical record.

Real savings, without cutting access or shifting costs, will require systematic improvements, and that is the kind of change that takes many years, even decades. So, what do we do?

* First, there are 50 million uninsured, left out in the cold; let's cover them.

*Second, cut known waste -- for example, Medicare and private payments to hospitals that discharge patients without coordinating aftercare and all-too-frequently re-admit them within weeks.

* Third, start the fundamental systems reform now -- the kind that the Congressional Budget Office (CBO) won't "score" for potential savings and that must be nurtured over many years to succeed.

*Fourth, pay for the gap between what CBO will and won't score.