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Murray Weighs in on Health Costs

There's a lot of talk about the need to control health care spending across the country. It's particularly so here in Massachusetts, where the cost of covering uninsured residents is threatening the state's reform plan.

Now Senate President Therese Murray is weighing in on the issue. She says, "There has to be climate change, otherwise our health care reform will implode under the costs."

Murray filed her health care "climate change" bill yesterday. It's a broad package that includes new requirements, more state spending, and greater scrutiny of health care costs. As WBUR's Martha Bebinger reports, Murray's goal is to unwind the spiraling costs of health care.

TEXT OF STORY:

MARTHA BEBINGER: Senate President Therese Murray is worried about spending on the state's health coverage law, and she calls this bill health reform phase two. It aims to control health care spending for and by everyone.

SENATE PRESIDENT THERESE MURRAY: Health care costs have become the number one issue facing our economy. These costs are not only squeezing our state finances, but they are also making it increasingly difficult for young people for families and businesses large and small and municipalities to make ends meet.

MARTHA BEBINGER: Murray explains her bill as many parts that as a whole will reign in costs and improve the quality of health care in Massachusetts. She'd tackle a shortage of primary care doctors with expanded tuition incentives, loan forgiveness programs affordable housing options and by recognizing nurse practitioners and physician assistants as primary care providers.

Murray would require that all insurers create uniform codes and billing to cut down on administrative costs. Doctors, hospitals and clinics statewide would have to switch to electronic medical records by 2015 and prove they know how to use them to register as physician.

Massachusetts Medical Society president elect Bruce Auerbach supports much of what's in the bill, but questions the electronic medical record requirement when the bill doesn't boost reimbursement rates for primary care doctors.

BRUCE AUERBACH: If we don't even have adequate reimbursement to support the physician practice thinking that there is this additional money to propagate electronic health records is another step away.

MARTHA BEBINGER: Murray is pledging $25 million a year to help providers adopt electronic record software and systems. She'd raise the cigarette tax to fund that and more. The state's E-Health Collaborative estimates it will cost about half a billion dollars to bring everyone who isn't using a connected computerized system on board.

Two other key pieces of Murray's bill add more state scrutiny and oversight of health care spending. The Senate President wants to review the rules about how much insurers and hospitals hold in reserves and she would require public hearings if insurance premiums are projected to rise more than seven percent a year, to find out why.

SENATE PRESIDENT THERESE MURRAY: There hasn't been enough oversight to find out what those cost drivers are. How much do you spend on marketing, how much is in your endowment fund, how much do you need in surplus and reserves. Those are the questions the public wants to know and the Commonwealth is a big purchaser of insurance.

MARTHA BEBINGER: Many insurers and providers say they welcome the chance to clarify what is driving health care costs. But Tufts Health Plan CEO James Roosevelt says there is some concern that Murray is moving towards the state setting health insurance rates.

JAMES ROOSEVELT: Transparency and putting forward the drivers of costs is useful. Creating a new process for approval of rates could not reduce costs but create a new bureaucratic scheme.

MARTHA BEBINGER: Looking at what drives health care costs is just the first step in figuring how to hold down increases. But Jon Kingsdale, who runs the Health Connector and is under a lot of pressure to reign in spending on the uninsured, says scrutiny is a critical first step.

JON KINGSDALE: The number one obstacle to cost containment is if people do not understand what the issues really are and what some of the options are. You know, you can't treat the patient unless you make the diagnosis first and in medicine that's often the most challenging.

MARTHA BEBINGER: Some health care economists say the only way to contain health care costs is to limit services, particularly the more expensive ones. Stuart Altman, the dean of the Heller School at Brandeis University says Massachusetts should be looking at a cost control strategy the federal government is reviewing, called comparative effectiveness.

STUART ALTMAN: To try to understand better which services are really that valuable to justify their high cost and which services we could either do without or use a different procedure to do the same thing.

MARTHA BEBINGER: But Altman says the Senate bill strikes a good balance.

STUART ALTMAN: It touches on a number of the key areas that many of us have been pushing without generating attacks on the legislation.

MARTHA BEBINGER: The Massachusetts Biotechnology Council is upset with a proposed ban on gifts from the pharmaceutical industry to physicians, and the bill leaves out any changes in medical malpractice law which many physicians have been urging for years. Murray says she expects the bill will change during debate in the Senate and in the House. But she wants it to be heard, argued, amended, approved, and signed by the Governor as of July, when this legislative session ends.

House leaders and the Governor have not said much about the bill and have not agreed to that timeline. But then they aren't saying it won't happen either. Here's House Chair of the Joint Committee on Health Care Financing, Patricia Walrath.

PATRICIA WALRATH: Well these are all subject matters that both house and senate matters dealing with health care have dealt with in one form or another and we all know that we've got to get a handle on the costs.

MARTHA BEBINGER: Governor Deval Patrick says Murray briefed him on the plan.

GOVERNOR DEVAL PATRICK: There's a lot of really good ideas in there and I look forward to working with her on that.

MARTHA BEBINGER: That's a better reception that many major bills receive on day one, which is not to say what will happen next week. That's when Senate President Murray's proposal to contain health care costs has its first joint House and Senate hearing.

For WBUR, I'm Martha Bebinger.

This program aired on March 4, 2008. The audio for this program is not available.

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