Posted on March 12, 2009

State must act to control costs of top-heavy health-care system


By Dr. Bruce Bender
Worcester Telegram & Gazette
Wednesday, March 11, 2009

Nearly three years after Massachusetts enacted landmark health care reform, the state can point to success in expanding coverage. But it has yet to address another significant issue: cost. By not addressing cost, the state puts the goal of universal coverage and the system in general at risk.

As it is, the cost of the subsidized insurance program, a key component of the reform bill, turned out to be much higher than expected. It will only get more expensive. Experts predict this program will double in size and expense over the next two years — and that was before Massachusetts’ recent economic decline that resulted in 50,000 lost jobs and an unemployment rate of 6.9 percent, the highest in 15 years. The number of residents who may join the ranks of the subsidized program will add to the programs’ costs.

What’s worse, the current program is not able to contain rising health care costs at a time when the state lacks financial flexibility, and is dependent on federal funding, which ends in two years, to help pay for the subsidized program. Even if the program’s costs held steady at today’s level, there’s no guarantee the state will continue to receive federal funding when the agreement ends.

That’s an important reason for Massachusetts to find ways to control costs. Otherwise, Gov. Deval L. Patrick, who has already proposed cuts in his 2010 budget, will have to raise taxes or cut services — or, more likely, do both.

Massachusetts should find ways to reduce the administrative costs of providing health care. Rather than pay an average of 34 to 38 cents of each health-care dollar, we should work to match the same percentage as Canada, 17 cents. This could save $9 billion annually, which could either help prevent the need to cut health-care programs or could be shifted to help our towns, schools, universities, parks, roads, and bridges.

One way to reduce administrative costs is to move to a single-payer system. Employer-sponsored health insurance is an extremely inefficient and expensive way to provide coverage, particularly given the number of small businesses in the state. Administratively, it is hugely expensive to determine which employees are eligible, notify them, explain the options, get them signed up or to sign a waiver sheet, etc. And small businesses are not eligible for the same benefits or prices as large businesses.

This uneven playing field places a substantial burden on business, one that impacts everyone in the state. Increased employer health costs mean increased prices on goods and services.

Employees should oppose employer-sponsored insurance because it is restrictive. An employee who has a special need that is better covered by a different program does not have that option. This is not because of the employer. It is because of the restrictions placed on so-called group insurance plans for small businesses. We cannot even offer all the plans within a single provider.

We provide in-home services to help seniors stay in their homes. This has been recognized by seniors, their families, and Massachusetts as a cost-effective solution. But many of our clients require part-time help — and part-timers run into problems because of restrictions placed on us by insurance companies. That’s why, despite paying 150 people each pay period, only about 30 meet the requirements placed on us by the insurers, which excludes 120 employed people from the system. Further, employees should not have to stay at a job that they hate, or work more than they can, or take a job because of the benefits.

The only sensible approach is the one adopted by every other civilized nation: a single-payer system. It would provide far more choice and better care, including preventive care, and be able to provide universal coverage, regardless of age, pre-existing conditions or work status.

Massachusetts has a responsibility to address cost and access issues before it looks for more money for an already failing system. Single-payer health care for Massachusetts can be the answer.

Bruce Bender, M.D., owns the Home Instead Senior Care franchise located in Northboro.