An Ineffecient System

Paul Krugman had another editorial in the NY Times today (click for article), this time exposing the vast inefficiencies inherent in our system. He points out that although Americans spend more than any other country, a huge amount of that spending is consumed by wasteful inefficiency. He estimates that there are 2-3 million people in American employed to shuffle papers—to try to get someone else to pay for the cost of health care.
Most experts agree that one of the reasons there is so much waste in health care is because it is not universal. Every time someone loses their insurance—and it’s easy to lose—it ends up costing us more to keep that person healthy.

Health Care Costs Sky-Rocket in Pittsfield

The Berkshire Eagle reported today about the skyrocketing cost of health insurance to the city of Pittsfield. Insurance fees are to rise $2.5 million, or 14% percent this year. Mayor James Ruberto expressed the need for a radical change to the health care system. "The health care system is broken. It is absolutely broken, and it needs immediate attention to determine how it can be fixed." (click here for full text)

The Robert Wood Johnson Foundation released a report (click here for full report) to launch its annual Cover the Uninsured Week (May 1-8). The report had several interesting findings specific to Massachusetts, among them:
- More than 1 in 10 have been without insurance for a year or more.
- 1 in 3 uninsured adults were unable to see a doctor when they needed one because they couldn’t afford to.
- Uninsurance rates for Blacks and Hispanics are much higher. Almost 1 in 4 Blacks and 1 in 3 Hispanics lacked coverage .
- To put it in context, Massachusetts had the second biggest gap in coverage rates between Blacks and Whites in the US – right behind Louisiana.

The RWJ report provides the hard numbers behind the human tragedies and moral outrage caused by uninsurance. After decades of reforms, income and race remain the major predictors of access to health insurance and of health outcomes. But uninsurance is a problem for everyone and the health care amendment will ensure that everyone can get affordable access to medically necessary care when they need it.

The New Caste System

WBUR Boston On Point last night aired a segment entitled “The New American Caste System: Insured and Uninsured in America.” The program discussed the hardships people face in getting and maintaining insurance. Callers talked about the difficulty underinsurance: being “covered” while having such high deductibles as to not be able to get medications, medical visits, and needed procedures. One theme that emerged from the program was the idea that no one is immune from losing their insurance, that everyone is only an illness away. Guests Susan Starr Sered and Rushika Fernadapulle, authors of the new book Uninsured: Life and Death in the Land of Opportunity, talked about stories from around the country (link to the program).

National Trends

In Vermont, the House passed a universal health care bill last week. While there are likely to be substantial changes made to the law as it works its way through the Senate, it is a strong first step, and more evidence that the health care crisis is becoming impossible to ignore. More and more states are taking concrete steps to solve the problem.

The latest Kaiser Health Poll Report found that Americans are more worried about health care than about losing their job, paying their rent or mortgage, losing money in the stock market, or being a victim of a terrorist attack. 49% said they are very worried about having to pay more for health care, 42% are very worried about not being able to afford the care they need, 35% are very worried they will not be able to afford prescription drugs, and 32% are very worried about declining quality of care. (Polled 1,203 adults, conducted March 31-April 3, +/- 3 %)

Baystaters share these worries. They believe health care should be the highest priority on the public agenda. Their greatest worries are access to health insurance and the cost of their health care. Time to lay the foundation for lasting statutory reforms with a state constitutional amendment.

Shifting the Costs

The Salem News reported recently that Salem city counselors will voluntarily contribute to the cost of the their health insurance premiums. Squeezed by rising costs and desperate to reign in spending, the city is looking for ways to reduce the cost of health care. This is a story being repeated in the cities and towns across the Commonwealth.
The city counsel’s action reflects what has often been the solution: pass along the costs to families and workers. Make employees contribute a larger percentage. The problem is, many employees do not have the money—the worker share of health care premiums is growing three and a half times faster than their wages.
In Franklin, the town counsel is considering plans to change retired teachers’ health insurance (link). The plan would move the teachers plan from the State plan back to the town plan, and the teachers’ premiums would rise from 10% to 32% of the plan’s cost. The teachers as one could imagine were not very enthusiastic about the idea.
As long as the health care system does not cover everyone, costs will continue to rise. That is why the constitutional amendment is critical—it ensures that everyone has coverage, and that the care is equitably financed and affordable. It ensures that costs do not get shifted around willy-nilly (to the teachers, the city workers, whoever), but instead requires that everyone pay their fair share.

Admistrative Burden

In an interesting op-ed (link) in today's New York Times, Paul Krugman discusses the differences in public vs. private administrative costs - 4% versus 15%. He argues that large private bureaucracies focus on “passing the buck” resulting in major cost shifts to individuals, employers, providers and the public health care programs. The answer? Take a long hard look at cutting administrative costs.
Other countries have systems providing coverage for everyone with administrative overhead close to 4%. MASS-CARE has filed legislation to achieve that goal. President Travaglini’s proposal, the Governor’s and Health Care for All’s rely more on market-based reforms.
Whatever the conclusion to the debate among competing reform proposals, the key role of administrative costs should never be lost.
It doesn't take much in administrative savings to cover the health care costs of the uninsured. In Massachusetts, moving from 15% to 14% - 1 percent point - saves $520 million. According to the Massachusetts Blue Cross Blue Shield Foundation, that's enough to pay for the care of today's uninsured (see report).
The constitutional amendment does not specify one approach over another. However, passing the amendment will require everyone—insurance companies, government officials, businesses, providers and all the other stakeholders, to sit down and figure out a solution that works for everyone. A leaner, less bureaucratic health care payment system has to be part of that solution.

New Health Care Poll

Poll results released yesterday provided new information about what Massachusetts residents think about health care. The poll was conducted by Tom Kiley of Boston and was commissioned by the Affordable Care Today Campaign – a coalition of 32 health care advocate groups, labor unions, consumers, doctors, and hospitals. Kiley said in a State House News Service article that “Compared to what we’ve seen in the past, it seems clear that the public is becoming more receptive to making major changes in the health care system.”
The poll shows an increasing number of residents are more concerned with the state’s health care system than they are about education, jobs, or taxes.
70 percent said they would favor a 50-cent cigarette tax increase, and 65 percent would support a new tax for employers whose employees use state-funded health care resources. Of those polled, 46 percent reported being “most concerned” with lack of health insurance and 40 percent were most concerned with the cost. People were also very concerned about the potential of increased taxes and extra burdens on businesses.
The concern over access to and cost of health insurance are particularly striking since 90% of those polled had insurance. It’s clearly not just a problem for the uninsured. It’s up front and center in the minds of a huge number of Massachusetts residents.
The poll surveyed 600 Massachusetts residents and had a margin of error of +/- 3.9 percent. (Click here for SHNS article)

Infant Mortality Rate

In Massachusetts, the latest infant mortality statistics tell stories of hope and tragedy. Massachusetts providers should be proud that we have lowest infant mortality rate in the nation. But it is a moral outrage that the black infant mortality rate (IMR) is triple that for whites. The Commonwealth is not unique but we can and must close this gap. According to the Globe, “A tinderbox of poverty, racism, and chronic disease fuels the gap in infant mortality rates.” The article also pointed out that the IMR, and specifically the racial gap, is “a bellwether of a nation's commitment to social well-being.”

The constitutional amendment is important for many reasons, one of them being the commitment to social justice. It is a statement that we all deserve quality health care, regardless of race, age, or income. The IMR gap on racial lines is more evidence that not everyone in the state has access to the quality, affordable care that we believe everyone is entitled to.

The Health Care Trap

A new Zogby poll illustrated the growing importance of health care costs to everyone, not just the uninsured. The poll also showed that Americans are more concerned about losing health insurance and prescription drug coverage than a job or a home. 84% of Americans said the number of uninsured as a “large problem”. The poll described a “health care trap” where 2 out of 5 workers would remain at jobs they disliked because they worry about finding health insurance and prescription drug coverage.
The Associated Press carried a story today about a Kaiser study that showed up to a quarter of seniors do not follow doctors orders regarding prescription drugs because of cost.
This is yet more data about the difficulty people are having affording the medicine they need. That’s why we need the constitutional amendment, to make sure everyone has access to affordable health care.

Happy Patriots Day!

Patriots Day is observed in just two states-- Massachusetts and Maine. The Holiday commemorates the start of the American Revolution in 1775.

The Ripple Effect

Paul Krugman today had a piece (link) in the New York Times in which he contrasted the American health care system to other countries’ way of providing health care. He pointed out that most other countries spend far less than we do on health care, but have better results in terms of infant mortality, life expectancy, etc.
One of the primary reasons (and there are many) why health care costs are so high in the US is the fact that our “system” fails to cover everyone. Excluding some people from reliable access to high quality healthcare inevitably raises costs for everyone. Each time someone loses their job, and with it their health insurance, costs rise for the rest of us. Each time a company cuts benefits, the costs for the system as a whole rise. In other words, when a person in Springfield loses insurance, the costs rise for the residents of the other the 355 other cities and towns in the Commonwealth, whether they have insurance or not. It may be just a penny or two but when you have over 500,000 uninsured it starts taking a big chunk out of your pay check in the form of higher premiums and taxes.

Cover the Uninsured Week is May 1-8. In the lead-up to the effort, the American Medical Student Association (AMSA) is promoting the Health Students Week of Action-- a series of coordinated events at each of the 50 state capitals to lobby for better access to health care for all patients. The AMSA effort will be April 25-29. The students who are working on this are the future of our health care system. We all want to ensure we have a system of health care that is always there for everyone who needs care. AMSA has endorsed the constitutional amendment campaign and we wish them success in their coming effort—for the sake of people everywhere in this country who suffer needlessly because they can’t see a doctor, afford medication, or get the help they need.

Middle Class Squeeze

On the 2006 election front, Deval Patrick announced today that he will run for Governor of Massachusetts. Patrick has been thinking of running for some time, but made the formal campaign announcement today. Patrick joins Attorney General Tom Riley as candidates for the democratic nomination for governor. (Globe Article)

Two Christian Science Monitor articles today tell the story of the squeeze moderate income Americans feel everyday. The first, (link), compares the income gaps between the rich and the not so rich in 19 advanced industrial countries. Not only does the US have the biggest and fastest growing income gap between rich and poor but lower income Americans, particularly children, suffer more than in our competitor nations. Why? A smaller and shrinking social safety net for everything from education and housing to retirement benefits and health care. The other article (link), tells the story of our ever flattening federal tax structure that shifts the effective tax burden straight to the middle class. What does this have to do with the health care constitutional amendment?

As incomes shrink and taxes take a bigger relative bite out middle-income workers there is less left over to pay for the basics – food, clothing, housing and health care. What used to be a problem for “them” is now a problem for all of us and the cost of health care coverage is one of the major drivers. How we solve this problem will surely require a healthy dose of Yankee ingenuity. But the constitutional amendment is the essential commitment to make sure we get the job done and start reversing the income squeeze that all but the most affluent experience every day.

Reform Plans Move Forward; Drug Prices Rise

The Boston Globe reported this morning that Governor Romney has begun airing a series of radio ads seeking to work with Democrats. He cited areas of common interest, including healthcare, as needing bi-partisan support. He also praised Senate President Travaglini’s proposal. The ads restate what all those who seek affordable coverage for every resident believe – we need to work together to accomplish this critically important goal. (See the whole article here)

The Globe also reported today that Democrats appeared to win three seats in special elections last night. Michael Moran, from Brighton, Linda Dorcena Forry, from 12th Suffolk, and Christopher Speranzo from 3rd Berkshire all won by safe margins. The electoral victories do not increase the Democrat’s margin on Beacon Hill (full Globe article).

An AARP study (link) showed that wholesale drug prices increased 7.1% last year. Everyone is feeling the heat from rising medical costs, and this is just more evidence. That’s part of the reason the constitutional amendment mandates affordable coverage.

Tennessee is planning to drop 323,000 people from the roles of TennCare (link). TennCare is the Tennessee Medicaid program, equivalent to MassHealth here in the Bay State. This is just another frightening example of people who rely on government aid abruptly being denied the help they need. The amendment would be a potential safeguard against these kinds of cuts.

Medicaid Troubles

State House News Service reported yesterday that the new Medicaid waiver will make it harder for the state to continue to get the federal support it has in the past. While some in Washington want to rein in Medicaid spending to control deficits advocates and governors are fighting to keep Medicaid funding to make sure the most vulnerable get the care they need. Check out Families USA to see what you can do.
A drop in Medicaid spending from the Feds will make it all that much harder for us to get to universal coverage since it threatens the coverage of the almost 1 million Massachusetts residents who rely on MassHealth for access to health care. However, it also heightens the importance of the constitutional amendment which makes a clear commitment to getting to affordable coverage for everyone. Only then will the families threatened by rising costs, shrinking benefits and loss of coverage know they can get the care they need when they need it.

Also in the news:

Former governor Michael Dukakis (who worked in the late ‘80s with the Legislature to pass legislation providing near universal health care only to see the critical employer mandate repealed by the next governor) spoke recently about the need for health care reform organizations to work together. He pointed out that we are all working for the same goal – affordable health care for all..

Both Governor Romney’s and Senate President Travaglini’s health care proposals have been referred to committee at the State House.

Current Reform Proposals

Well, so far there are four health care expansion proposals on the table. Governor Romney, Senate President Travaglini, Health Care for All (HCFA), and MASS-CARE, have all put forward expansion proposals. While there is still a huge amount of negotiating and comprise yet to happen, the outlines of the various campaigns are starting to emerge.
Romney’s proposal focuses on signing up people eligible for MassHealth, and providing tiered insurance subsidies for low- and middle-income families. He is pushing a tiered approach to insurance—the amount of state subsidies would vary with family income.
Travaglini (full text) wants to halve the number of uninsured by expanding MassHealth enrollment and cutting premium through market based reforms. He wants to reform the small group and non-group markets so they get the lower rates large employers get. He also proposes charging “free riders”, employers who don’t cover their workers, when their workers use MassHealth or the Uncompensated Care Pool to pay for their care. His plan also funds a study to look at an individual mandate for health care coverage, something like auto insurance.
HCFA’s proposal also expands access to MassHealth for various groups of people and proposes a variety of reforms to reduce costs and improve quality of care. Its unique contribution is that it requires employers to either cover their workers or pay an assessment.
MASS-CARE (full text) supports a single payer bill—all medical payments would come from the same pool of money eliminating billions of dollars of administrative overhead and waste that can be used to pay for expanded coverage. There are also several quality control elements included in the bill.
We’re thrilled at the quality and quantity of proposals on the table, and look forward to a good debate about each one. While each takes a different approach to covering the uninsured, all agree that lack of health care insurance is a big problem. That’s the problem supporters of the constitutional amendment want fixed. The amendment is not a solution itself, but it requires that a solution be found. Once the debate is over and the Legislature finds a “fix”, the Amendment will keep the “fix” in place. If the fix doesn’t go all the way to affordable coverage for everyone, the Amendment is there to get the rest of the job done.
The amendment is two things in relation to these proposals: 1) a statement of principle saying we need to take care of our citizens, and 2) a commitment that whatever proposal emerges as law remains law, a promise that once people get access to affordable health insurance, they keep it.

Trav unveils plan

Yesterday, Senate President Travaglini unveiled his health care proposal. Key highlights included $116 million for increased Medicaid provider payment, $25 million for public health, and $15 million to help insurers cover catastrophic costs. Like the governor's proposal, we're happy about anything that furthers the discussion of health care reform. Its simply unacceptable that more than half a million Massachusetts residents have no health insurance. Travaglini's proposal also reminds us why we need a constitutional amendment—once enacted, his proposal won’t be the first expansion enacted in this state. An expansion in 1988 included an employer mandate that was repealed before it ever went into effect. We’re all still fighting to restore the cuts to the 1996 expansion that created MassHealth. Two steps forward – one back. The constitutional amendment would make sure that we keep marching forward to coverage for everyone, that each health care expansion is part of a permanent fix.

Blog Launch!

The Health Care for Massachusetts Campaign is pleased to announce the launch of its campaign blog! Folks from the campaign will regularly update the blog with campaign goings-on and news. It’s the place to find all the latest campaign news and information.

Yesterday, campaign co-chair Barbara Roop appeared at a live New England Town Meeting on the Uninsured hosted by News Center 5's Natalie Jacobson (click here). After a comment made by Barbara on the need for a constitutional amendment, Natalie asked Senator Richard Moore, chair of the health care financing committee, whether he supported the health care constitutional amendment. He said he supports the amendment, and that he voted for it at the first constitutional convention.

Gov. Romney, Sen. Moore, John McDonough from Health Care for All, and others were on the program talking about various ways of reforming health care in Massachusetts. Everyone agreed that something must be done and that every resident in the state should have access to affordable, comprehensive and high quality health care coverage. The constitutional amendment will be the glue that holds the plan together, and makes sure that it is permanent fix to the state's health care problem. The amendment will be the permanent promise we make to ourselves and each other about the necessity of affordable health care for every Massachusetts resident.