A [Massachusetts] official may have gone off-script last week, but what he had to say is an important contribution to the state’s ongoing debate over reining in health care costs.
Terry Dougherty, director of MassHealth, the state’s Medicaid program, was addressing a budget hearing in Boston Friday, State House News Service reports. He noted a little-known fact that runs counter to the widespread assumption that government is more wasteful than the private sector.
MassHealth, which insures nearly 1.3 million Massachusetts residents, spends just 1.5 percent of its $10 billion budget on administration, Dougherty said, while private insurers spend about 9.5 percent of their revenue on administration.
“I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,” Dougherty said. Under a single payer system – like MassHealth or Medicare – the government pays health care providers directly, instead of an insurance company.
Unlike private insurance companies, Dougherty said later, at MassHealth “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth … who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.” Source: The Milford Daily News
From the The Milford Daily News
A group of 51 legislators - including two area lawmakers - is trying to push the state's landmark 2006 health care reform law even further by establishing single-payer health care. "Could the reason this bill enjoys so much support by legislators be because only 60-70 percent of our health care dollars are actually spent on health care," Patrick asked of the Joint Committee on Public Health yesterday. "Could it be that legislators deal directly with the discontent of constituents under the current 'revamped'system in Massachusetts?"
Patrick said a single-payer system would control the problem of rising health care premiums, which he said have increased by 130 percent nationally since 1999. Patrick said the problem of rising premiums is even more pronounced in Massachusetts, and have made the state's current health care system unsustainable.
"We have the highest cost for health care, per capita, in the history of the world," Patrick said.
Dr. Stephanie Woolhandler, professor of medicine at Harvard University, testified that studies in the New England Journal of Medicine have shown a single-payer system would reduce state health care costs by 15 percent, amounting to $9 billion in savings. Contact Congress in support of the National Single-Payer Amendments Now. Of special importance to the Massachusetts legislation is the Kucinich Amendment to H.R. 3200 on the House, which enables states to enact their own single payer programs without running into problems with ERISA laws.
UPDATE: I neglected to mention that Pennsylvania is also experiencing a push for Single-Payer:
Close to 1500 Pennsylvanians packed the main capitol rotunda recently to call for passage of a bill that could make their state the first in the nation to put a single payer health insurance plan in place. Following the rally, the crowd broke into smaller groups, and many headed for the offices of key legislators to urge support for the two key bills which would bring a single payer plan to the keystone state. House Bill 1660 and its companion Senate Bill 400 have the support of organizations ranging from PNHP and the Progressive Democrats of America to the Pennsylvania AFL-CIO, represented at the rally by its president Bill George, to the non partisan League of Women Voters. Governor Ed Rendell has said he would sign single payer legislation if it reaches his desk.
From Jonathan Cohn:
Ten years from now, if health care reform is a boondoggle, you might be able to trace that failure back to a decision in the wee hours of last week's Senate Finance Committee hearings.
It happened on Thursday night, just before midnight, when John Kerry put forward an amendment. It was amendment C-8: "Empowering State Exchanges to be Prudent Purchasers." The title may sound innocuous, if a bit arcane. But if you've followed the health care reform debate, then you know (or should know) that anything involving the insurance exchanges is important.
And Kerry's amendment is very important. The bills moving through Congress all set up exchanges modeled more or less on what Massachusetts has done. But there are a few critical differences. Among the most important is a difference in how the exchanges would select which plans to offer people.
In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a "prudent purchaser." In other words, it would have a staff that bargained with insurers to bring down premiums--and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a "Good Housekeeping Seal of Approval" from the administrators. This is precisely how it works in Massachusetts.
By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.
Jon Kingsdale, who runs the Massachusetts exchange, calls that a recipe for "policy disaster," as consumers faced a dizzying array of more expensive, less regulated choices. "It would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery. ... The exchanges would be nothing more than an automated Yellow Pages."
Kingsdale is among several Massachusetts-based policy experts who have been ringing the alarm bells about this flaw in the Finance bill. And it's no coincidence that it's a Massachusetts senator, Kerry, who now proposed to fix it by giving the exchanges the same powers envisioned in the House and HELP bills.
But when Kerry introduced his plan last week, he couldn't get the votes to pass it. The reason, several sources on Capitol Hill say, was opposition from Olympia Snowe, the Maine Republican who also sits on Senate Finance. Snowe seems to be concerned that a more aggressive exchange would amount to more government--which, in fact, it would be. But, as Massachusetts has shown, sometimes more government is exactly what health care needs.
Chances are reasonably good that Kerry's vision of reform will prevail, if not during the Senate floor debate then afterwards, when a conference committee merges whatever passes from the two congressional chambers. But it's not a sure thing, which is why this seemingly narrow question deserves a lot more attention.
Exchange design doesn't get the attention of controversies like the public option, abortion, or supposed death panels. In the long run, though, it could be far more decisive in whether reform works. Read it all at The New Republic
"With Congress expected to debate health care reform next week, advocates of a single payer health care system rallied Wednesday outside the Springfield office of Massachusetts Congressman Richard Neal." Listen to audio at WAMC:
By Susanne L. King, M.D. - Berkshire Eagle Online
Sen. Bernie Sanders, a Vermont Independent, has just introduced a single-payer health care reform bill into the United States Senate. This legislation stands in sharp contrast to the reform models offered by the White House and Sen. Max Baucus, which are similar to our current Massachusetts reform. Unlike Massachusetts, the Sanders bill would eliminate the many private insurance companies and create a "single payer" to administer health care funds.
Single-payer health care would save American taxpayers $400 billion in administrative costs, says Sanders, which would be enough money to provide health care coverage for everyone in our country. Sanders is a senator who knows how to save money at a time when taxpayers are paying billions to keep AIG afloat.
As we know from our Massachusetts experience with health care reform, preserving the role of private health insurance companies does not lead to universal coverage or contain rising health care costs. The Massachusetts reform program has not been affordable for the individual or for the state, and access to health care continues to be problematic, with nearly a quarter of the state's residents saying they had difficulty getting care in 2008.
The provisions of Senator Sander's bill are: (1) universal coverage; (2) comprehensive benefits, including mental health, dental and prescription drug coverage; (3) patient choice of doctors and hospitals; (4)fully-funded community health centers to provide access to care for the 60 million people living in rural and other underserved areas; and (5) resources for the National Health Service Corps to train 24,000 new health professionals to address the shortage of primary care doctors and dentists.
Massachusetts continues to have a critical shortage of primary care doctors, and providing health insurance for the uninsured through our current program has only made that deficiency more visible. Having health insurance in Massachusetts doesn't guarantee health care if you can't find a doctor when you are sick. Others with insurance can't get care because they can't afford their co-payments and deductibles.
Sanders' program would be paid for by taking the current sources of government health care spending, and combining them with modest new taxes that would be less than people now pay for insurance premiums and other out-of-pocket expenses. Four hundred billion dollars would be saved annually by eliminating insurance company profits and overhead, as well as the paperwork that burdens doctors and hospitals.
Dr. Uwe Reinhardt said at a hearing before the U.S. Senate Finance Committee, "We have 900 billing clerks at Duke (a 900 bed university hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed. . . it's obscene."
Doctors and hospitals are sick of the paperwork and the health care dollars that don't go for health care delivery. And everyone hates the intrusion of insurance companies into health care decisions. A poll published in the Archives of Internal Medicine found that 64 percent of doctors in Massachusetts now support single-payer health care.
Sen. Bernie Sanders' legislation is a bold step forward. Five hundred physicians in Massachusetts have signed a letter to Sen. Kennedy, asking him to support a single-payer reform similar to Sanders' bill. Kennedy supports universal coverage, but would leave the current dysfunctional system of multiple insurance company payers intact. Kennedy has said, "Health care is not just a commodity . . . to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American."
Unfortunately, leaving the current system intact would not save the $400 billion now lost to administrative expenses. We ask Sen. Kennedy to listen to Massachusetts physicians and reject the lobbying forces of the profit-driven insurance industry. We also ask him to join Sen. Sanders in sponsoring the only solution for health care reform that will cover everyone at a cost we can afford. Susanne L. King is a Lenox-based practitioner.
By Trudy Lieberman: Three years ago the Commonwealth of Massachusetts enacted a far-reaching health reform law that politicians and the media hailed as a model for other states and the federal government. Indeed that law has become the major blueprint for health system change on a national scale, and its advocates are aggressively marketing some variation of the Massachusetts plan as the reform of choice. Until recently, there has been little analysis of how the law has worked. Today we begin a series of posts that will explore the Massachusetts law with an eye toward helping the press and the public understand the flashpoints as legislation based on the Bay State’s experiment winds its way through Congress. Until recently, few have criticized the program. One health care provider who asked for anonymity told me: “Nobody wants to be quoted as going against Senator Kennedy. Nobody wants to be the one who says the emperor has no clothes. If you or your organization speaks out, you get cut off politically.”
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