The unrelenting supporters of the single-payer approach to health reform have updated their website. And, it is a quite an update. The old MassCare site was sluggish — infrequently updated and often lacking links to upcoming events. Check it out here or click below. Also in health reform, check out WBUR’s Q & A with David Seltz, the new head of the state Health Policy Commission.
Can one state take over its entire health insurance industry? We’ll find out in Vermont. Here are some links w/ more details
From The Rutland Herald:
MONTPELIER — Health care advocates and Democratic politicians on Thursday cheered a Supreme Court decision that preserves the foundation on which Gov. Peter Shumlin plans to build the nation’s first single-payer health care system.
While he vowed earlier this week to proceed with a publicly funded, universal system regardless of how the country’s highest court ruled on the Affordable Care Act (ACA), Shumlin said Thursday that the federal subsidies included in Obamacare will ease Vermont’s transition to single payer.
From Kaiser Health News:
KHN’s Marilyn Werber Serafini talks to Anya Rader Wallack, tapped to move Vermont toward a single payer health care system, who is confident the state would enact its own individual mandate requiring people to buy insurance if the Supreme Court strikes down the federal mandate. Still, finding the money to replace the lost federal subsidies won’t be easy. Wallack says, “We’ll have to cover [people] without adding new resources to the system or raising taxes at the state level. Both of those are difficult for a little state.”
While you’re at it, check out the Health Wonk Review’s two-part take on reform;
SCOTUS on health reform – the bloggers respond: Part 1 & Part 2.
As a freelancer, I’ve been known to grumble about doctors who write. After all, why should they hog the Pulitzers and the pages of The New Yorker when they have perfectly good day jobs? On the other hand, doctors in print often offer us an alternative to the mass-marketed Dr. Oz or the perky, laminated docs on daytime TV’s “The Doctors.”
So put down that Parade magazine. (We’ll admit that Dr. O has some good advice about sleeping problems.) Instead, check out the always rich “Ideas” section of The Boston Globe, where you’ll find a column by MGH doc Suzanne Koven on doctors who write.
Perhaps so many doctors are writing literature today as an antidote to our increasingly rushed and technological medical practice. There’s less time or incentive to include, in the modern case history, vivid descriptions of a patient’s appearance, details about his occupation and family life, or musings about what might ail him, than there were 100 years ago. When Oliver Sacks showed his friend, W.H. Auden, film clips of the stiff and mute patients about whom he wrote in “Awakenings,’’ he asked the poet “What do you think they lack?’’ “Music,’’ Auden replied. Doctors who write literature supply the grace notes missing from today’s medical records, recapturing the music of the human condition.
Maybe. The column arrives in anticipation of the release of an anthology “Writer, M.D.: The Best Contemporary Fiction and Nonfiction by Doctors,’’ edited by Leah Kaminsky . And the story includes a list of other works by doctor-writers.
Writing about
patients can generate compelling narratives. Try pitching a story on health reform. So, we are surprised to see that you need to buy a ticket for the Cambridge reading Jonathan Gruber’s Health Care Reform: What It Is, Why It’s Necessary, and How It Works. Maybe we should learn to draw: it’s a comic book.
For a more text-based, deeply informed view of politics and health reform, check out the free discussion by Stuart Altman and David Shactman of “Power, Politics, and Universal Health Care’’ on Monday at 7 p.m. at Brookline Booksmith. Altman, a Brandeis professor, has been bouncing back and forth between Waltham and Washington for years. He knows his stuff.
Some of the BoSox players were lifting chicken legs instead of weights last spring, but not Ellsbury and Pedroia. Jacoby returned from an injury for a great year and Dustin was solid all season.
The Globe’s Daily Dose offers some advice from their off-season trainers, who counsel them “on the importance of sleep, self-massage to relieve soreness, and what they need to eat to help build muscle.”
Also, please note this week’s publication of the Health Wonk Review, the biweekly digest of the best of health policy blog. This edition includes links to posts about the upcoming Supreme Court decision on insurance mandates, HIT and primary care and the new Independent Payment Advisory Board. Also note the previous edition, brought to you by Center for Objective Health Policy, a site that encourages “individuals to apply free-market ideas to healthcare.”
Harvard School of Public Health Panel
Before you write off these folks, note that a recent survey of doctors by the Massachusetts Medical Society found that a growing number of doctors support the idea of a single-payer system. More than 40 percent, up from 34 percent last year. So do a lot of folks at Occupy Boston.
OVERVIEW: While the Massachusetts health reform law of 2006, widely regarded as the model for the new federal health law, reduced the uninsured population in the state, it did so at the cost of rapidly rising underinsurance, increased health care premiums, and a financial crisis among the state’s safety-net hospitals and community health centers. And the financial burden of the reform has fallen disproportionately on lower-middle-class families.
Those are some of the findings in a new, exhaustively documented report on the outcomes of the Massachusetts reform law released by Mass-Care and Massachusetts Physicians for a National Health Program. The report draws on hundreds of sources, including academic studies, government statistics and scientific surveys, in the first compilation of its kind.
EXECUTIVE SUMMARY
The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available publicly subsidized private health insurance for additional low-income residents of the state. It also mandated that all but the poorest uninsured residents either purchase private health insurance or pay a substantial fine (up to $1,212 in 2011). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance.
Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.
Reform has had a positive impact on access to care in the state, but this impact has affected a modest share of residents, and for some patients has been negative. For example, some low-income patients who previously received completely free care under the state’s prior free care program faced new co-payments and premiums after becoming insured, which impeded their access to care. Reform has not reduced the burden of medical bills and medical bankruptcy on Massachusetts’ families.
The growth of residents with insurance coverage has exacerbated a primary care shortage in Massachusetts by increasing wait times for appointments and decreasing the portion of physicians accepting new patients, creating access problems even for those with coverage. Reform did not reverse growing use of the state’s emergency departments for care, despite expectations that expanding insurance coverage would reroute patients through primary care offices. There is no evidence as of yet that expanding insurance coverage has had an impact on health outcomes or disparities in health outcomes. Reform has also created a financial crisis for safety net providers that specialize in care for low-income communities and the uninsured, by shifting resources away from safety net providers while patient demand for safety net care has actually increased.
The public cost of reform has been high, exceeding $800 million in fiscal 2009 for a state with a total budget of $32.5 billion. However, federal taxpayers paid for the bulk of the law’s public expenses. The state has made a broad range of cuts to the original law in order to its keep costs down, cutting back coverage for over 30,000 documented immigrants, curtailing some benefits, increasing cost sharing, and increasing the share of enrollees required to pay premiums. Substantial funds from the federal stimulus bill were also used to sustain the reform law, but this was a short-term fix only.
Public payments account for only a portion of the reform law’s costs. A central premise of the law was that the state, employers, and individuals would all have to sacrifice financially to approach the goal of universal coverage. This premise of “shared responsibility” for the costs of the reform was in many ways disingenuous. Although employers, individuals, state and federal government have shared the burden of increased costs roughly equally, this overlooks the fact that governments pass on their spending to taxpayers, and employers pass on their costs to employees. The actual burden of health reform was regressive, with increased spending after health reform falling disproportionately on lower-middle income residents.
The reform failed to “bend the cost curve” in Massachusetts because it contained no significant cost-control provisions. Health care costs in Massachusetts are higher than in any other state in the nation, and reform has been found to accelerate the rising costs of employer-sponsored health care. There is general agreement that the Massachusetts reform is itself not sustainable without effective cost control.
Massachusetts enjoyed favorable circumstances at the outset of reform, such as previously high levels of spending on health care for the poor, high personal incomes, and relatively low rates of uninsurance. Without controlling costs, national reform will run up against the same difficulties as Massachusetts: growth in public insurance coverage will prove unsustainable and will accompany the rapid erosion of private insurance benefits, while modest gains in access to care will be threatened in the short term by unsustainably high costs that are increasingly shifted on to patients.
While Massachusetts health reform has enjoyed support from a majority of residents in the state, that support has declined since national health reform instigated a broader debate over alternatives to the Massachusetts plan. Moreover, while residents support the Massachusetts reform law over no change at all, they have expressed increasing skepticism that the law is working for vulnerable communities, and more residents report that the law is hurting them than helping them.
We believe that the data in this report should give pause to those concerned with national health care reform. Although not without its successes, the Massachusetts reform has not addressed the fundamental deficiencies in the health care system – treating symptoms rather than causes – and even its modest successes are unsustainable for the state and Massachusetts residents.
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