States Offer Critiques, Advice On Reform

Various states weigh in about health care reform with particular concerns about financial difficulties and different reform models. Massachusetts looks to its own experience to offer advice.

The Boston Globe reports: "If you want to know how the proposed overhaul of the US healthcare system may play out nationally, talk to top executives at the biggest medical and life sciences companies in Massachusetts. As the heads of leading hospitals, insurers, and biotechnology companies, they have dealt with the complexities of near-universal healthcare since 2006, when Massachusetts became the first state to mandate insurance coverage." As the debate over health reform continues in Washington, the executives offer warnings that two Obama administration goals - expanding insurance coverage and controlling spending - are potentially incompatible. "As Massachusetts strains to deal with the increasing costs of its successful healthcare program, they raise questions about who will pay for the projected $1 trillion cost on the federal level."

The Massachusetts executives say that the health care system needs major surgery and have a range of concerns, including cost and unintended consequences of reform: "Hospitals and doctors say that lower federal reimbursements could hurt the quality of medical care, while insurers chafe at a proposed government-run health plan they argue would put them at a competitive disadvantage. ... At the same time, biotech and medical-device makers say the focus on cost savings could hinder their ability to develop life-saving drugs and innovative devices. ... Hospital executives said those steps [to increase coverage of uninsured] may eventually pare expenses, as will preventive care if more people sign up with primary care doctors." As the federal government proposes to reduce its reimbursement payments to hospitals, these facilities also may feel the pressure of more patients.  According to Paul Levy, prseident of Beth Israel Deaconness Medical Center, "What you could get is a gradual degradation in the ability of hospitals to deliver services,'' (Weisman, 7/28).

USA Today reports that Vermont took a different approach to reform from Massachusetts, but the state also could provide a model for the national level. State health care workers say Vermont has innovative approaches to prevention and care coordination, as well as new computerized records systems. 

"Massachusetts' health care overhaul included a costly mandate that nearly every resident have insurance, paid for by employers, insurers and taxpayers. Covering the uninsured is at the heart of the debate in Washington also as Congress struggles with whether to offer — and how to pay for — health care for more than 46 million in the USA without insurance coverage." Vermont  took a different path. Officials there "focused on cutting costs and improving care, with the goal of insuring more people. They won over critics in the Legislature and the public by not raising taxes. Instead, the state convinced insurance companies and hospitals to kick in. The federal government gave Vermont flexibility in how to spend Medicaid dollars. The only hit to the public: a tax on cigarettes that is 80 cents per pack and a $365 per employee penalty for businesses that don't offer health insurance. The program is new, and cost-savings results that might draw critics aren't in" (Hall, 7/28).

Meanwhile, the Houston Chronicle reports that executives of Texas Medical Center sent a message to Congress to "slow down." "Appearing at a news conference sponsored by U.S. Sen. Kay Bailey Hutchison, R-Texas, many of the medical center's biggest names said the issue is too important to rush through legislation that could have unforeseen harmful consequences. ... Afterward, some of the leaders acknowledged the time needed might extend past 2009 but said it's more important to pass a good bill than to meet an arbitrary timetable."

The Houston Chronicle reports: "Every major medical center institution was represented. Though each brought its own concerns, they were united that reform is necessary but that Congress needs to tread carefully to preserve the best of American health care while it tries to fix what's broken. They complained that Congress has done little to solicit input from the medical community. ... Medical center leaders' criticism of reform efforts include: no mechanism to pay for the expanded coverage by cutting waste, fraud and errors; no attention paid to the role of illegal immigrants on health care costs; and no emphasis on prevention and graduate medical education" (Ackerman, 7/27).

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