"The Ethics of Health Care Reform: Striking a Balance Between Affordability and Coverage" by Bruce Bullen

Harvard Pilgrim Health Care regularly convenes an Ethics Advisory Group (EAG), made up of health care consumers, employer customers, health care providers, academics, and others, who volunteer their time to help us evaluate business problems that test our values framework. The Group’s advice on how to approach business challenges ranging from high-deductible products to joint ventures to protection of member privacy and confidentiality has been invaluable to Harvard Pilgrim staff and leadership.

On April 5th the EAG tackled the question of what values framework would be most appropriate to help Harvard Pilgrim meet the challenge of Massachusetts Health Reform. A key focus of the discussion was on the values most relevant to striking a balance between affordability and coverage.

In its deliberations the EAG strongly endorsed the goals of Health Reform but had several concerns.

For instance, individuals are required under the law to have “creditable” health insurance but are limited as to what kind of coverage is “creditable.” The EAG was concerned that mandated creditable coverage would not be affordable and that inequities would result when low-income purchasers were forced to pay a higher percentage of income than higher-income purchasers. The EAG also worried that the minimum standards for creditable coverage may require some persons who are currently insured to buy up to more comprehensive benefits than they wish to purchase or can afford. And finally, the EAG noted that, while insurers are being asked to create “affordable” products, little public attention is being focused on the 80+% of premium costs being billed by providers. With hospitals running at capacity and physician office practices largely filled there is little provider incentive to reduce charges.

In context of these concerns, the Ethics Advisory Group saw Massachusetts Health Reform as a laudable attempt to solve what have been intractable policy problems in all 50 states. Although the effort will place difficult demands on health plans, the EAG agreed that Harvard Pilgrim’s mission and status as a not-for-profit plan require it to do all it reasonably can to help the reform program succeed. Accordingly, the EAG recommended a set of core values that were most relevant for guiding our response. These included telling the truth, even when the truth is unpopular; educating constituents and treating them fairly; and being a responsible corporate citizen.
In advising that we always tell our constituents the truth the EAG noted that, if it is not always possible to offer comprehensive coverage at the premium levels being sought, Harvard Pilgrim should say so. By advising that we educate our constituents and treat them fairly, the EAG referenced a need for corporate transparency and recommended that we balance the interests of all constituents and not shift costs from one group to another. Finally, by recommending that we remain a responsible corporate citizen the EAG cited a need to meet the goals of Health Reform without jeopardizing our health and stability.

Sound advice, we think, for all who wish to see Health Reform succeed.

Bruce Bullen, COO, Harvard Pilgrim Health Care