Conceiving an Elephant but Giving Birth to a Mouse
The Incredible Vanishing Push for Universal Health Insurance in Massachusetts
By Alan Sager, Ph.D., Professor of Health Services
Commentary, WBUR-FM Boston Broadcast 20 March 2006
For months, most of us have thought that the Legislature was debating how to cover the three-quarters of a million people in Massachusetts who lack health insurance. But legislation expected to be released this week suggests that when it comes to improving coverage, state government conceived an elephant but gave birth to a mouse.
Let’s follow the money. Over the next three years, business will pay about 144 million dollars more to help cover uninsured employees, while hospitals and others will get 540 million dollars more through Medicaid rate hikes. At the same time, the increase in overall total health spending to finance business as usual will be 25 billion dollars here in Massachusetts.
Why did the goal of insuring people get lost?
Here are some of the reasons.
Support for expanding health insurance has been broad but shallow.
Powerful hospitals and insurers did a better lobbying job than access advocates.
Health care costs so much that no one could find enough money to finance good insurance for people who can’t afford it. Instead, I expect, the legislature will pass the buck and compel individuals to buy flimsy but costly insurance. Business groups said the state’s economy would suffer if employers had to spend a lot more to cover people. But 540 million dollars more for hospitals and 25 billion dollars more for business as usual? No problem.
That’s a cruel double standard.
Since 1987, when our state last tried to insure everyone, health costs have risen by 40 percent as a share of our state’s economy. And 80 percent more people are uninsured—mainly because of higher premiums.
Access advocates ignored cost control for fear it would antagonize powerful hospitals, and that it’s too complicated for legislators. Gov. Romney and Pres. Bush take different approaches but essentially have the same cost control plan—bad insurance that makes sick people pay more out of their own pockets. That won’t encourage careful shopping. It will turn patients into the victims of a cost control war.
Higher out-of-pocket payments plus flimsy insurance will satisfy Washington’s demand that more people look insured on paper, permitting the state to retain special Medicaid payments. But higher out-of-pocket payments won’t cut waste. About half of our state’s 59 billion dollars in health care spending this year will be wasted—on administration, unnecessary care, excess prices, and
outright theft.
Our state’s 25,000 doctors decisions control almost all health spending. Past cost controls have failed because doctors didn’t support them.
Let’s negotiate a trustworthy deal with doctors.
Here’s the deal’s outline. Doctors, if you agree to take care of all of us with the 59 billion dollars already available—that’s over 9,000 dollars per person—we’ll eliminate malpractice suits and 90 percent of your paperwork.
All of us seek medical security—high-quality and timely care, without worries about bills or losing insurance.
We already pay enough. U.S. health spending is four times defense spending. And Massachusetts per person health spending is the world’s highest.
Rising health costs put us all at-risk. Let’s contain cost before the next bad recession and state fiscal crisis hit. Because when the economy stops short, Massachusetts health care will crash through the windshield.
Alan Sager is the Director, Health Reform Program Boston University School of Public Health