Our 'Reform 2011' Forum Wants You! Presenting Guest Post #1: 'HMO Deja-Vu'

Thanks to WBUR's Martha Bebinger and an all-star team of guest posters, CommonHealth served a unique role documenting the debate that culminated in the passage of the landmark Massachusetts health overhaul of 2006. (The full archives are here.)

Now, Gov. Deval Patrick has just officially launched Health Reform II, and all the signs are pointing to 2011 as the year for the second great wave of health care reform here. Once again, CommonHealth aims to serve as a forum for the exchange of interesting and important thoughts on what should be done. To offer a submission or sound us out, please just hit the "Get in touch" button below. Warning: We must be merciless about keeping guest posts readable and user-friendly. The piece below is an example of how punchy writing and strong opinions can bring a potentially soporific subject to life.

Our guest poster: Dennis Byron is a researcher in enterprise software market statistics who has just started his own blog on Massachusetts health care statistics here. He's an active commenter on CommonHealth who casts a gimlet eye on the results of health care reform so far, and I'm always grateful when he writes in because he has a spot-on detector that picks up when I've glossed over something or failed to ask the right skeptical questions. He describes himself as semi-retired and "clearly with too much time on his hands;" I hope that remains true enough for him to keep commenting.

Patrick's Proposal: Too Soon To Tell But...

By Dennis Byron

The details of the latest of many Massachusetts health care reform efforts are still dribbling out. But the message is unclear. It's either the beginnings of socialized medicine in the Bay State or it's a moderate attempt to slightly tweak a world-class healthcare delivery system to make it better. In reality, it's too soon to tell. It's not just that you probably still have not read the actual 50-pages-plus of proposed legislation but, more important, the legislature is going to change it anyway just as it has changed a half-dozen or more "health care reform" efforts dating back to the 1970s. Last year alone the Great and General Court changed the "2006 reform" twice.

But if history is any indicator, get your two cents' worth in now because the changes are going to be made in a back room on Beacon Hill and signed into law at 11:30 pm July 3rd.

My personal take is that both the current proposal and the 2006 effort are/were solutions looking for problems. The combination of the two is not going to change anything and might make things worse.

I admit that when I see propaganda, I assume I am getting a snow job. For example:

· Even if you believe the 2006 reform was only about universal insurance coverage --and not cost control – it failed; it's not universal. And it appears to be pretty easy to get a waiver according to recent press reports.
· Even if you believe there’s now a higher percentage of covered individuals (I do), that’s all free or highly subsidized insurance. The actual people just plain buying insurance in Mass. is down since the real Romneycare penalty kicked in as of January 2008.
· Even if you believe that the Patrick administration lowered small-group/individual health insurance rates in 2010 by freezing the market twice, once the insurers finished rating those of us in small groups or those that buy individually for zip code, age, whether we are right- or left-handed, etc. the rate increases were right back up there (20% last year for me).
· Even if you believe the latest American Health Rankings or the Commonwealth Fund report that say we're number two in the country overall and in Children's Health respectively (I don’t believe in contrived indices), so what? It has nothing to do with the 2006 laws. Massachusetts has always had great health care.

But Governor Patrick apparently does not agree. According to the Boston Globe, the governor says: “(the Massachusetts healthcare) system doesn’t provide the best care for patients..."

That's insulting to the docs and others that provide our health care. In a quote from the press release, Patrick seems to accuse them of greed and avarice. Apparently admitting how illogical it was to say that the problem with health care costs is how we pay for it (last month’s progaganda), the message now is that the problem with health care costs is really the way the doctors deliver it. I guess that he could find no statistics that backed up the illogical "global payment system" argument so he has resorted to this "Accountable Care Organization" (ACO) proposal, even though many people in Massachusetts tried HMOs (the same thing as an ACO) in the 1970s and 1980s and found them unacceptable. [module align="center" width="full" type="pull-quote"]No one will answer the question: How is it going to be different this time?[/module]

On the good side, the latest announcement does at least pay lip service to malpractice insurance reform and it did not mandate ACOs and global payments. But in the legislative phase of Health Care Reform Number 7, don't hold your breath for the malpractice changes. And watch for the ACO mandate to appear just about the time the fireworks go off over the Hatch Shell.