'Mountain Climbing' by Dolores Mitchell

While many of us in the health care “space”, as some like to call it, are waiting for Congress and its five committees that are involved in health care legislation to come up with something we can respond to, we, in the Commonwealth are plowing along, trying to come to grips with our own great piece of unfinished health care reform business, namely cost control and its first cousin, payment reform. Proceedings of the Cost Containment committee have been concentrating on the many options that have been espoused over the years to contain costs, and the committee is now poised to begin making some choices among them. At the same time, the Payment Reform Commission, moving with admirable speed, has already selected one path, from among four or five possibilities, and is beginning to tackle the issues of how to get from here to there. The road taken is global payments as the preferred substitute for fee for service. So now begins the hard part — definitions of what level of aggregation is intended for those global payments, who will get them, who will distribute them, and how will they be allocated. We also have to figure out how to include self insured purchasers in the new system, and how long a transition can be tolerated, given the economic circumstances of 2009, 2010, and who knows how much longer.

We have considered short term strategies in less detail than the longer term goals, but short term “fixes” have to be considered if we are to make a contribution to helping the commonwealth with its fiscal problems. It is indeed flattering to hear the number of national opinion makers and opinion writers cite the commonwealth’s reform package as a model, but we enacted that major achievement of access before the economy went south, and trying to deal with the cost components in a time of extreme economic stress makes a Mt. Everest out of what was two years ago, just a normal Rocky Mountain peak. It was hard enough then; it’s a major endeavor today. Having said that, I am struck once more, with the intention of all the participants to make it happen. The true test will be when proposals that demand some sacrifices are put on the table for a decision. I can think of no solutions that, at least in the short run, will not involve some sacrifices — in income, or autonomy, or power. As congress deliberates, my hope is that once again, Massachusetts will lead the way. They may have better weather, but we’ve got the moxie — I hope.

Dolores L. Mitchell, Executive Director of the Group Insurance Commission of the Commonwealth of Massachusetts, the agency that provides life, health, disability and dental and vision services to over 300,000 State employees, retirees and their dependents.