Boston Globe: Sachs, Angell, weigh in on health care reform

Jeffrey  Sachs of  Columbia University is not a health care guy; he’s a big picture guy. One in  a series of lengthy columns in The Boston Globe offered this:

captureOBAMACARE INCREASED health care coverage but did not solve the crisis of sky-high prices, and may well have exacerbated it by adding government subsidies into a system marked by pervasive market power and lack of competition.

I therefore recommend the following policies to address America’s urgent health care crisis.

First, as I’ve suggested in previous articles in this series, America should adopt policies to reduce income inequalities, end the over-incarceration of the poor, empower workers, clean and green the environment, and raise the social status of working-class families. Over time, such measures would help to reverse the epidemics of drug abuse, mental illness, obesity, and other diseases exacerbated by poverty and low social status.

Second, America should move toward universal health care coverage through public financing, as in Canada and Europe, with health providers (both private and not-for-profit) supplying coverage on the basis of capitation rather than fee-for-service. Capitation would encourage and enable health providers to offer supportive services (nutrition counseling, social support, health advising) that help to prevent, treat, and manage chronic conditions such as cardiovascular disease and adult-onset diabetes.

Third, the government should move to a system of price ceilings for medicines under patent through rational guidelines that balance the incentives for R&D with drug affordability and access. Economists have long argued that today’s patent law does not do an adequate job of balancing the needed incentives for innovation with the assurance of access to affordable medicines. The situation became intolerable after the advent of Medicare Part D, with the government now spending vast sums for drugs and drug companies grossly abusing the system by setting outrageous markups on the cost of production.

None of this is a dream or a utopian vision. These reforms would simply put the United States on the path toward improved health care coverage, affordability, and outcomes already enjoyed by the citizens of Canada, Japan, and many countries in Europe.

To which Dr. Marcia Angell, a former NEJM editor vocal critic of health care profiteering, had this to say:

JEFFREY D. SACHS has written an excellent overview of what makes the American health system so inadequate, inequitable, and expensive, compared with other advanced countries, and he recommends some important reforms. But one of them — paying providers a set yearly amount for each patient covered (capitation), instead of paying on a fee-for-service basis — would not work in this country, because, unlike other countries, our providers are largely for-profit (or behave that way).

Can #Massachusetts tame #health #spending with transparency and oversight?

Stuart Altman, the Brandeis University healthcare economist who has advised presidents from Nixon to Obama, talked to Health Leaders last week. He is capturenow  the head of the Massachusetts Health Policy Commission, which tracks total health spending statewide.  

HLM: How is Massachusetts trying to address high costs?

Altman: First of all, it is the only state that has recognized that it should be involved in total state spending. Some other states that are closer are Vermont and Maryland. But the Massachusetts state government is really acknowledging that it has responsibility for not only what it spends on Medicaid, but that it should be concerned with total spending.

Full story at Health Leaders. 

Are two big #hospital groups better than one? #consolidation

At Wednesday’s meeting, the  Massachusetts Health Policy Commission heard a staff report on the proposed merger of Beth Israel Deaconess Medical Center

Capture

From the report. AMC= academic medical center

 In summary, we find that these transactions are anticipated to increase market concentration, solidify BIDCO’s position as the second largest hospital network in the state, and could strengthen BIDCO’s ability to leverage higher prices and other favorable contract terms. However, BIDCO’s market share will remain far smaller than the dominant system in the state for most services.

Member of the commission pondered the impact of having two large hospital systems, instead of just one giant one — Partners. Their conclusion — no one really knows, but it would be worth finding out.  We’ll see where that goes.

From the Globe:

“… commissioners noted that the growth of Beth Israel Deaconess Medical Center and Beth Israel Deaconess Care Organization, or BIDCO, could be a good thing. BIDCO is a network of affiliated doctors and hospitals that negotiates contracts with insurers and gives its members set budgets under which to manage patient care.

“To me, big is not necessarily bad,” said Marylou Sudders, the state secretary of health and human services, who sits on the commission. “Shouldn’t Massachusetts have… a strong competitor to what is the largest and most expensive health system?”

The commission said that by adding MetroWest and the Baptist to its network, BIDCO will solidify its place as the state’s second largest provider network. But it will remain much smaller than Partners, with about 13 percent of all hospital discharges, compared to 29 percent for Partners.

 

Health care in Massachusetts: Affordable or not?

Not affordable: From this week’s paper

Rising health care costs have outpaced the incomes of Massachusetts families over the past decade, despite efforts by the state to control medical expenses, according to a report released Wednesday.

Affordable: Two weeks ago.

Despite concerns about rising health care costs, the head of the state’s largest and most expensive network of doctors and hospitals said Thursday that health care is “very affordable” in Massachusetts.partners

Partners HealthCare chief executive Dr. David Torchiana, in remarks to the Greater Boston Chamber of Commerce, acknowledged that health care costs are higher here than in other parts of the country, largely because Massachusetts is home to several large teaching hospitals whose training and research programs make them expensive to run.

But considering the high incomes in Massachusetts, it’s not so bad, Torchiana said: “Health care is very affordable in Massachusetts.”

To help make sense of this and other health policy debates, check out the latest Health Wonk Review.

Former Tufts doc: “Widespread dishonesty” leads to unjustified health care fees #HCR

Former Tufts doc and current Mainer Howard A.Corwin comments this weekend on the latest in Elizabeth’s Rosenthal’s great NYTimes series on insane health care costs. In her latest piece, she reports that “In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees.”

To which Corwin notes: 

To the Editor:

Doctors call such billing “gaming the system.” There is widespread dishonesty that leads to these unjustified expenses throughout the medical profession. Members of Congress beholden to medical lobbyists allow flawed reimbursement systems and perpetuate them by preventing reform. There is an enormous disparity between what different medical specialists and personnel earn. Unable to rectify these disparities, many physicians resort to these gaming techniques. Unnecessary expensive tests and procedures, upgraded coding, “scratch my back and I’ll scratch yours” referrals and, of course, outright greed lead to extra medical expense.

Honest doctors are demoralized and suffer from this system. Doctors must regain leadership of medicine to rectify these aberrant and destructive practices.

HOWARD A. CORWIN
Center Lovell, Me., Sept. 21, 2014

The writer is a former clinical professor of psychiatry at Tufts University School of Medicine.

Globe: For-profit hospitals in low-income communities want a cut of high fees paid to competitors #healthcarecosts

It is well documented that some Massachusetts hospitals –– read Partners — have the bargaining power to  extract higher pay rates from the feds and private payers.  Today’s Globe offers two takes on the ongoing battles.

This one is behind the paywall: 

images stewardA new coalition led by the state’s biggest health care company and its largest health care union will be pressing for higher payments to community and safety-net hospitals, saying patient care is threatened by a widening gulf between health care in rich and poor areas.

The group, calling itself the Massachusetts Healthcare Equality and Affordability League, will be formally launched Thursday by Steward Health Care System, a for-profit cluster of community hospitals, and Local 1199 of the Service Employees International Union, which represents more than 47,000 workers at sites that care for blue-collar and low-income patients.

And while it would not the odd to hear heated rhetoric from 1199, the story quote Steward’s chief executive, Ralph de la Torre, calling the disparity  “socioeconomic bias and bigotry.”

More on de la Torre in this Globe magazine profile. 

During his career, the 44-year-old heart surgeon-turned-hospital executive has shown himself to be a brilliant maestro, time and again using his relentlessness, charm, vision, and opportunism to turn an array of opponents into a symphony of supporters.

His most recent symphony was his most impressive work. As CEO of the Caritas Christi hospital network, he pushed through an $895 million deal late last year that took a group of community hospitals founded primarily by nuns to care for the poor and put them in the hands of the New York private equity giant Cerberus, a firm that takes its name from the mythical three-headed dog guarding the gates of Hades. To steer the deal through, he orchestrated an unlikely alliance of the Boston Archdiocese, Democratic elected officials, the Service Employees International Union (SEIU), and community organizers in some of the state’s poorest cities – all to support turning the struggling nonprofit hospital chain into a for-profit operation owned by a group of high-flying financiers

And an editorial calling for a correction to high rates driven by a formula designed for struggling rural hospitals. The state’s only technically rural hospitals is in tony Nantucket.

SINCE 2010, Massachusetts hospitals have benefited from an annual bonus in Medicare funding of at least $250 million. Congress is expected to vote to eliminate this windfall in early June, a blow to local hospitals, which may face layoffs and cuts in patient care as a result. But as the system is set up now, the state receives these funds due to a loophole in the national health reform law and at the expense of at least 40 other states. It’s time to find a more sustainable and equitable way to support top-notch medical care.

Single-payer health reform advocates launch new website #HCR #mapoli

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.

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