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"One Step Up, Two Steps Back" by Richard T. Moore

“We've given each other some hard lessons lately,
But we ain't learnin.'
We're the same sad story, that's a fact;
One step up and two steps back.”
Bruce Springsteen – 1997

These are among the words of the title song of a Bruce Springsteen album a decade ago talking about blue-collar woes, lost loves, found loves that didn’t pan out, and lives chafing against the status quo. They could just as easily be the theme song for those of us working to advance health reform during an economic recession.

Massachusetts’ landmark health reform law passed in 2006 has, according to the Connector Authority’s October 2008 report, achieved an unparalleled 97% health insurance coverage. About half of that coverage is privately paid by employers and workers, and the rest is paid by taxpayers either completely or with some individual financial participation. The Commonwealth is on the verge of providing virtually universal health coverage, and the individual stories of lives saved are truly heartwarming!

Surely, no one can again ask if it’s possible to achieve universal health coverage. But now we must ask, for how long?

Health care in America is expensive, and the cost keeps rising. The cost is also hard to justify when matched with outcomes in the quality and safety of the care! Making health care reform sustainable was the focus of Chapter 305 of the Acts of 2008, Senate President Murray’s “Health Reform II” – the Quality Improvement, Cost Containment legislation.

In an economy that will, undoubtedly, make more people eligible for tax-supported health care coverage because incomes will slip below the federal poverty level standards, and more employers and employees will reduce coverage to cut costs, the historic expansion of coverage achieved in Massachusetts is now at risk. However, in our zeal to find budget savings, we must not make it more difficult to maintain our successful experiment in health reform or to sustain that reform in the future by cutting back efforts to improve health quality and safety or to contain spiraling cost increases.

Among the 9C cuts announced recently by the Patrick Administration were reductions in the funding for expansion of primary care providers or electronic health technology; and for continuing the work of the Betsy Lehman Center for Patient Safety, the Massachusetts Quality and Cost Council, and the Statewide Infection Prevention Program. In a period when cutting back, reducing expenses is required by tough economic times, there is a tendency to wrongly focus only on the short-term savings. We’re missing the larger picture of health reform sustainability through quality improvement and cost containment. These cuts fit the definition of the old adage of being “penny wise, and pound foolish.” They irresponsibly undermine our state’s ability to sustain health coverage, not just for the working poor, but for all residents of Massachusetts!

The Betsy Lehman Center, named for a woman who was the victim of medical mistakes, has demonstrated the need for focusing on safe best practices in health care. At a time when one-third of patients responding to a Kaiser Family Foundation/Harvard School of Public Health Survey on Consumer’s Attitudes on Patient Safety report having been personally involved in a preventable medical error, we should not be curtailing efforts to improve health care safety.

When the Institute of Medicine, in its Guidelines for Clinical Practice, reports that “the evidence base for known effective and safe care–especially medical practices–is limited,” does it make sense to cut the Lehman Center or to wipe out the staff of the Quality and Cost Council, especially when the Council is just beginning to share comparative data on health providers?

Research has demonstrated that e-prescribing and electronic health records, as well as expanding access to more primary care providers over higher costs medical specialists can save lives, but also trim millions of dollars in avoidable costs in the delivery of health care. It will take much longer to achieve these goals and send the wrong message to health care providers and their patients by cutting programs designed to improve the effectiveness of health care delivery.

If the Patrick administration and the Legislature hope to close the revenue gap and restrain budget growth in years to come, reining in the cost of health care, improving quality and safety, and expanding access to primary care providers needs to be a priority. The latest round of state budget cuts suggests that they are not!

Senator Richard T. Moore
Co-Chair, Joint Committee on Health Care Financing

This program aired on October 30, 2008. The audio for this program is not available.

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