Health Coalition: We Can Reduce Costs Without State Regulation

A screengrab of the plan

A screengrab of the plan

BOSTON — A coalition that includes health care industry leaders in Greater Boston and health economists has put together a draft plan for how to bring health care costs under control.

The message from the Eastern Massachusetts Healthcare Initiative to Gov. Deval Patrick and the Legislature is: we can reduce spending without more government regulation. More regulation, the group says, might make things worse than they are now.

WBUR’s Martha Bebinger joined All Things Considered host Sacha Pfeiffer to detail the plan.

– Here’s the coalition’s plan (on Scribd):


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  • Phil Edmundson

    Who is in this group?

    • Martha Bebinger

      Hi Phil – here’s the latest membership list I have for the Eastern Massachusetts Healthcare Initiative:

      Hospitals and Medical Groups:

      Atrius Health
      Beth Israel Deaconess Medical Center
      Boston Medical Center
      Children’s Hospital Boston
      Dana-Farber Cancer Institute
      Lahey Clinic
      Massachusetts Eye and Ear Infirmary
      Partners HealthCare
      Tufts Medical Center
      Winchester Hospital

      Health Plans:

      Blue Cross Blue Shield of Massachusetts
      Harvard Pilgrim Health Care
      Neighborhood Health Plan
      Tufts Health Plan
      Stuart Altman chairs the group.  Another four or five prominent health economists are involved.  I’m not sure if they are members or advisers.

  • Barry Hock

    I had to look up a spelling and just learned that “bologna” is the mystery meat and “baloney” means nonsense. This proposal is both.

    • Martha Bebinger

      Hi Mr. Hock – why?

      • Barry Hock

        Hi Martha – As you noted, this is an attempt to avoid rate regulation and other proposals in the Governor’s payment reform bill. For starters, based on this slide deck:

        The proposal kicks the can down the road three years – after the 2014 effective date of much of the federal health reform law, which will change the health care landscape considerably. And yet, there’s no reference to federal reform in the proposal. Moreover, many insurer/provider contracts are already in place for the next three years. Are they to be re-opened? If not, then what’s the point of a three-year transition period?

        The proposal is heavy on suggestions and light on requirements and enforcement. Slide 13: “The Independent Commission should be mindful of price variations when tracking spending.” Does this mean that price variation will be duly noted but nothing done about it? What will the Attorney General think of that?

        What are we to understand from the important assumptions in slide 15 that there will be savings in Medicaid (“assuming appropriate rate structure”) and Medicare (assuming a federal waiver)?

        While health plans might look forward to shifting risk to providers, and the large providers may be sophisticated enough to understand and manage the risk, one wonders how small-sized providers (see the example of the stand-alone PCP practice in slide 19), bedside caregivers and the rest of the direct caregiver system will manage risk. On the other hand, there’s only one incidental mention of quality (a departure from the conventional wisdom that quality brings cost savings.)

        It’s also unclear what role the state agencies would play. Would they even be represented on the independent commission? The proposal explicitly excludes someone from a state agency being Chair of the commission. In slide 7, enforcement mechanisms “would not be imposed during the three-year transition period, but would be imposed after that time if the Commission finds benchmarks are not being met”. So, even when enforcement finally arrives, some of the stakeholder Commission members could be in a position of either penalizing themselves or their competitors. In contrast, the Health Connector Board has no health plan or provider representatives; and the Connector Chair is the Secretary of A&F. Where’s the public’s voice in the proposal?

        In sum, it’s hard to see how this proposal leads to the dramatic changes that are necessary in the system.


  • Keithdouglas

     There is only one way to reduce Health care costs. Adopt Preventive Medicine, Discard Tertiary intervention, as the Primary modality. Corporate Industrial Medical Intervention, formerly referred to as ‘Healthcare,’ is a business and, as such, it’s primary interest is to stay in business. If anyone is unclear on this simply look at the ever growing physical plants of the Hospitals in the city of Boston. This growth will continue to need to be fed.  The Interventions which Industrial Medicine has to offer are expanding, an expansion which would diminish in the adoption of a model Prevention. The lip-service given to Prevention and the obfuscation of ulterior motives via ‘screening’ vs, again, Prevention, is completely transparent to this 30 yr veteran of the Industry.
     This Industry depends on illness. It grows with illness. It’s boards of trustees demand growth. The Medical Industry’s inability, or rather unwillingness, to take decisive action against the Food, Insurance, Pharmaceutical, Medical Education, and Political Industries, it’s bedpartners, shows a callous disregard for the Health of the Public. It chooses, instead to hide behind euphemisms such as ‘evidence-based practice,’ in order to turn a blind eye  from issues clearly related to health and wellness, but may be, in it’s eyes, poorly documented through research.
     Medical Schools crank out Doctors who leave with back-breaking debt. Many of these people approached the field in order to help through Family Practice, Primary Care &c., yet they cannot do so in a way which would be sound to them. Instead they are forced into high-tech, high cost, high revenue Specialties in order to simply pay off their debt. 
     The Medical Industries careful and cut throat elimination of most of it’s competition, using this same lame argument of ‘evidence-based’, again, shows a self-serving disregard for Healthcare as defined by the needs of the patient/public, choosing instead control over access to Alternatives through deceit and the dissemination of misinformation. Medicine defines ‘evidence’ and discards all which falls outside of it’s definition. Yet, it’s own claim of being ‘evidence-based’ is only a part of the truth. Much of what it does, in practice, is no more science, by it’s own definition, than those Aternatives which it eschews out of hand. 
     American Medicine certainly has a place in Healthcare. It is up to the Public to define and put it in it’s place, not the reverse as has been the practice to date.

  • Susan Regence

    Another way is for each of us to take more interest in the care of our health by asking a lot of questions of our doctors and demanding full answers. Ask about costs – because prices do matter these days. Ask about alternative treatments, exercise or diet options instead of medications. Or when meds are necessary, ask about generics. This gives some ideas: http://whatstherealcost.org/video.php?post=five-questions

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