Catching up, at home and in MA.

Been away a while while graduating/taking the bar/subletting my apartment & moving. Now I'm trying to sort through old news & catch up with the new. Onward!


On March 15, 2009, NYT published an article on the costs of care in MA & how the Commonwealth is trying to deal. Costs were high in the projected plan, and have soared even higher.

Alan Sager, a professor of health policy at Boston University, has calculated that health spending per person in Massachusetts increased faster than the national average in seven of the last eight years. Furthermore, he said, the gap has grown exponentially, with Massachusetts now spending about a third more per person, up from 23 percent in 1980.

All of that, and still 2.6% of residents, 167,300 people, are not covered. Now, while that's comparatively nothing to sneeze at, we still have to contemplate just how much money is being spent, and that the return is not universal.

Why do we care about health care in MA? Well, beyond the general desire to watch an experiment at work, the Obama administration has certainly taken a liking to it, and even without Daschle, the Plan is peppered all over policy talk from the White House.


The article offered a very nice nutshell of Phase I of the MA plan, which was simply getting it enacted, including the sell of Mandatory Coverage. Phase 2 of health care reform in MA involves an ambitious restructuring of payment schedules.

They want a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided. ... If Massachusetts becomes the first state to make this conversion, health policy experts argue that it would be as audacious an achievement as universal coverage.

Again, significant on a Federal level. Paying for quality instead of quantity is already creeping in to the Federal system (for example, Medicare's new non-reimbursement rule for certain complications after patient admission), and managed care organizations have also experimented with/enacted various quality-based payment systems very similar to what MA may be proposing. This proposition is not without logic since chronic disease is a huge chunk of health care spending, and can either be prevented or effectively managed by patients and doctors for lower costs overall.

Of course the problem of determining sufficiency of quality is common to pretty much every health care delivery quandary: WHO decides? But that's a post for another day.


The article goes on:

Those who led the 2006 effort said it would not have been feasible to enact
universal coverage if the legislation had required heavy cost controls. The very
stakeholders who were coaxed into the tent — doctors, hospitals, insurers and
consumer groups — would probably have been driven into opposition by efforts to
reduce their revenues and constrain their medical practices, they said. Now
those stakeholders and the state government have a huge investment to protect.

Well wasn't that a slick move.