"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 20, 2005

Here's the text of a letter published in today's Boston Globe in response to comments by Gov. Romney's aide on hospital billing practices (see May 18 post):

TIM MURPHY, Governor Romney's policy director, has said that hospitals should be more aggressive in their billing practices and use all legal options to collect from ''recalcitrants" (''Romney aide targets debt at hospitals," Page A1, May 18.)

There are four flaws in the administration's claims:

The administration does not take into account the patients' ability to pay. Punishing patients who need healthcare and cannot afford to pay for it by placing liens on their homes and garnishing their wages is not the answer.

It fails to recognize that hospitals charge the uninsured, who have the least ability to pay, the highest rates for medical care, often two to three times what insurers have to pay.

The administration's comments let employers off the hook. Employers have to take responsibility for failing to offer coverage to their employees or only offering coverage with unaffordable deductibles.

And, most important, the comments fail to recognize what every patient knows -- that healthcare is not a luxury. Hospitals should not take a more aggressive tactic with debtors than other industries because patients do not choose to need healthcare.

If the governor wants the confidence of consumers as he pursues a healthcare reform agenda, he should disassociate himself from Murphy's comments.
JOHN McDONOUGH, Executive Director Health Care for All Boston

Let us know your thoughts and reactions.

May 19, 2005

Stupid: The trend in health care is clear -- make consumers pay more for everything everywhere. Copayments, deductibles, premiums and more. A new study from the Center for Studying Health System Change provides a good window into the way this cost shifting hurts. In 2003, more than 14 million adults with chronic conditions -- half low income -- could not afford their prescriptions; African Americans were twice as likely to forego needed medications. The numbers facing this problem are growing because of increasing co-payments and other cost sharing. Short term savings, long term higher costs.

Smart: An alternative: in 2003, Pitney Bowes ended co-payments for prescription drugs for their employees and families with asthma, diabetes, and other chronic conditions. After the change, PB found their overall health spending went DOWN as more workers and family members complied with their recommended treatments and medications. This was described in the Wall Street Journal in a May 19, 2004 article: "Higher Co-Pays May Take Toll on Health."

May 18, 2005

Governor Romney's chief health policy advisor, Tim Murphy is quoted in a front page Boston Globe story as berating hospitals for not pursuing more aggressively patients with unpaid medical bills. Murphy describes hospital practices as "passive" and suggests the Governor will address this deficiency in yet to be filed legislation.

Do we need any more evidence why consumers should be cautious about Governor Romney's "reform" intentions in health care?

If Gov. Romney wants to delve into this issue, we hope he will also address hospitals who bill uninsured patients at two to four times the amount they bill private insurers for the same services.

We hope he will address the issue of ability to pay. Right now, co-pays, deductibles, and other cost sharing are imposed on consumers with zero regard for ability to pay. So that $2000 deductible hits families with incomes over $100,000 and under $20,000 equally, but with no regard to their economic circumstances.

We hope the Governor will address employers who are hitting their workers with deductibles now rising as high as $10,000 per year before a penny of insurance coverage kids in, as well as employers who provide not a penny of health coverage to their workers.

As the Globe article mentions, a 1999 study shows that over 90 percent of bad debt was connected with patients who qualify for support from the state's Free Care Pool. These are families struggling to make ends meet, not the "bad actors" Tim Murphy likes to complain about.

Bottom line: medical debt is one of the two largest factors in all personal bankruptcies in the United States. For information on the consequences of medical debt, see this report from the Access Project.

If Governor Romney wants consumers to believe he has a clue what real families are facing, he needs to disassociate himself from these remarks, and fast.

May 17, 2005

This blog was the first to break the news (eee May 5 posting) that State Health & Human Services Secretary Ron Preston would be leaving his post in the summer. Now we're the first (as far as I've seen) to report that his acting replacement will be current Undersecretary Steve Kadish. This is good news. Kadish is smart, talented, and respected. He's taking over at a critical time for state health reform and the reorganization of the EOHHS. It would be good news if he were the permanent replacement -- and I hope that doesn't jinx him.

Meanwhile, Senate Ways and Means released their FY06 budget plan today and did a solid and commendable job on key health issues, including:

* Full funding for MassHealth HIV, Breast and Cervical Cancer, and Insurance Partnership;
* Funding to allow 26,000 more enrollees in MassHealth, icnouding 10,000 more in MassHealth Essential for very low income long term unemployed persons;
* Full restoration for 3,500 senior and disabled legal immigrants;
* Full funding (and affordable premiums) for Children's Medical Security Plan and Healthy Start;
* Restoration of smoking cessation and dental benefits for pregnant women and new moms (we will continue our push for full dental restoration for all 560,000 adults);
* Full funding for the hospital Uncompensated Care Pool;
* Full funding for Prescription Advantage including an open enrollment period.

Sincere thanks to Senate President Bob Travaglini and Ways and Means Chair Therese Murray for a great job!

May 16, 2005

On Tuesday, State Senate Ways and Means Chair Therese Murray will release the Senate leadership's version of the FY06 state budget. It will be debated in the Senate beginning next Monday, going for two, three or four days most likely. After the House produced a fiscally restrained budget that left advocates across the board disappointed, expectations are higher for the Senate version.

On health matters, we're waiting to see items such as: funding for MassHealth, especially for programs such as MassHealth Essential which is facing an enrollment cap, restoration of benefits such as adult dental, funding for the uncompensated care pool, public health, children's health access programs, and the Prescription Advantage program for seniors and disabled. Amendments, which can only be filed by Senators, will be due on Thursday.

May 13, 2005

The most convincing explanation for horrendous annual increases in health costs and premiums is the relentless pace of new tests and technologies used by all of us. Today I was part of this as I celebrated my first colonoscopy. In truth, it wasn't an eager embrace. My doc told me to do it two years ago and I avoided it like the plague; only later did he take away my choice in the matter and schedule it for me. And like a good boy, I did it.

My insurer is Harvard Pilgrim and I use Harvard Vanguard's Kenmore Center which has a spanking new endoscopy/colonoscopy center on the first floor. And are they busy! 50 a day, 250 a week, 13,000 a year! 13 docs and several dozen nurses. I don't know the charge, but it's got to be a pretty penny, especially times 13,000.

Is all this really necessary? Yes. Colon cancer is the second most common cancer after lung (breast cancer is second among women, prostate second among men -- but colon cancer is third among both genders so it's the second most common overall). And it's totally preventable. So an expensive procedure that prevents many cancers also adds many dollars marbled into our health insurance premiums. Five years ago, hardly any one was getting this procedure. Yes, the cost effectiveness of this procedure has been verified in numerous studies (click here to see a few), but those savings offsets occur years into the future while the cost of testing happens today.

The event itself? The prep the day before is nasty. The procedure is, well, kind of groovy. If you want enough drugs, you won't remember a thing except a blissful feeling; if you take a little less, you can see and recall a televised "fantastic journey" into your you-know-where in dazed marvel. (Guess which I chose.) It's worth the trip, for all of us.

By the way, I asked the doc to check if he could find any sign of my head up there, since so many folks have wondered over the years if that's where it's most often located. No sign of it, he told me.

May 12, 2005

Thanks to FamiliesUSA founder, Phil Villers, I just found out about a first-rate exploration of the options for state health reform prepared by the savvy folks at the Frameworkers Institute. This analysis was done with the state of Arizona in mind -- though its findings and insights are applicable in any one of the 50 states. It's a thoughtful and carefully done exploration of the four major options for state health access reform: 1. public utility model (aka -- single payer); 2. employer mandate; 3. expansion and opening up of public programs; and 4. tax credits. No slam dunk for any option -- just a well done exploration of the possibilities and problems with each.

I suppose I should add a big "wonk" alert here. But, heck, these issues are tough and demand serious and thoughtful exploration. Let us know what you think.

May 11, 2005

Yesterday, in a back room in the Massachusetts State House, eight senators and reps along with about ten legislative aides, met with oral health advocates to establish the first state legislative oral health caucus in the nation. Oral health? You mean teeth? Yes, and a lot more. Oral health, good dental care, is intimately tied to one's overall health. Yet medicine and public policy have encouraged a separation which leads to awful policy choices such as the elimination of adult dental services from the Mass. Medicaid program in late 2002. So here's how it works now -- MassHealth will only pay for dental services for adults when teeth get so rotten they need to be pulled -- aka, extractions. After they're pulled, the state no longer pays for dentures to replace them. Blenders and straws become essential items of daily living. That's why we tip our hats to: Chairs -- Sen. Harriette Chandler and Rep. Kathy Teahan, and Co-Chairs -- Sen. Bruce Tarr (R!) and Rep. Cheryl Rivera. These folks get it, and we appreciate their leadership. We're making a big push right now (right now!) to restore adult dental benefits in MassHealth. Please help us by taking 53 seconds to send an email to your state senator to support this. Click here, and thanks!!

May 10, 2005

American journalism's prince of darkness, Robert D. Novak, wrote on Sunday's Boston Herald that Gov. Mitt Romney "in a recent secret Washington meeting with national political operatives, signaled he probably will forgo seeking re-election in 2006 in order to pursue the 2008 Republican presidential nomination. Romney did not flatly reveal his future intentions, according to sources who were present. but he did say a presidential race would be difficult if he were concentrating on a 2006 campaign for governor and were still in that office in 2007-08."

Tied with other recent Administration moves -- Health & Human Services Chief Ron Preston departure this summer, Romney's Admin & Finance Secretary Eric Kriss leaving this fall -- we wonder, what effect will all this have on the prospects for comprehensive health reform between now and the end of 2006?

The Administration needs to develop major health access legislation to propose to the House and Senate or risk losing hundreds of millions of dollars tied to the new federal Medicaid waiver. The brain drain, potential lame duck status, and potential loss of a state focus do not auger well for such a high intensity/high profile initiative. This would leave legislative leaders in a much stronger position to direct a reform agenda -- and leave the Governor with only a veto to make his mark.

In some ways this resembles the last major health reform drive in 1996 when Gov. Bill Weld, seeking to win Sen. John Kerry's seat, was a passive observer of that year's health reform, and his veto was easily overridden by the House and Senate in July 1996. It's impossible to predict how this will play out. The one certainty, if Gov. Romney becom

May 9, 2005

It's feast or famine time for health reform. Vermont, Maryland, Maine among others push the limits to expand coverage while Tennessee, Missouri and others push backwards. Last Thursday, California rejoined the former set when a Senate Committee voted 7 to 4 to approve a single payer tax-financed health reform bill. This same committee approved a similar bill in 2003 which passed the full Senate in scaled down form. Ultimate, both branches passed an employer insurance mandate which was repealed narrowly by voters in November 2004.

Click here to read details from Associated Press. Little trivia -- lead sponsor is State Senator Sheila Kuehl who, in an earlier life, played Zelda Gilroy on the 50s TV show, Dobie Gillis. California has a curious history on health reform, especially when it comes to ballot initiatives. In 1992, the voters rejected an employer mandate; in 1994, they rejected a single payer plan, 73-27%; and in 2004, they again rejected an employer mandate, 51-49%. That's a tough crowd to please out there!