In King Richard III, the Duke of Gloucester says “it is the winter of our discontent”, but for some of us, we could say that this has been the summer of our discontent — everyone has been treading water, waiting to see how the national election turns out, watching oil prices bounce up and down, with the stock market following right along, the housing and banking sectors in distress, and the almost daily question — “are we in recession — yet?” And the answer generally being — “not quite, but close” — not exactly reassuring words.
All of this, of course, makes life more difficult for our sector, health care, particularly in Massachusetts where health care is a cost driver and simultaneously an economic generator and a job creator. Growth, in economic discourse, is usually viewed as a good thing, but it is also a matter of concern to payers, purchasers, and budget-watchers, since we all know that if you build it, people will come, and there goes the budget.
So what does all this have to do with health reform? As Jon Kingsdale noted in his recent monthly report, the Connector’s need for additional revenue this year has come as a consequence of its success in enrolling more uninsureds than planned for. My agency has had its budget problems too, as utilization climbs. So volume counts, and so does price — and supply does drive demand. We know all this, but what we don’t know or don’t have agreement on, is what to do about it. All of us who work in state government are on notice that our FY09 budgets are subject to change, — down, not up, so health care costs are of concern to all of us — public and private sectors alike.
A lot of good people are working very hard on a number of fronts to deal with aspects of reform — encouraging transparency, funding disease management and wellness initiatives, looking for ways to simplify administrative procedures — every one of them useful contributions to reform. But the basic values, structures, and delivery systems of health care in this country are basically pretty much as they have been for decades. We used to be able to afford its inefficiencies, but those days are over.
Basic reform in this country has almost always occurred as a result of cataclysmic events — depression or war — or when the middle class itself is threatened. We are perhaps closer to the latter scenario than we would like. The Massachusetts Health Reform Acts of 2006 and 2008 called for shared responsibility. It may be that 2009 will call upon all sectors — hospitals, doctors, medical schools, businesses, and patients to dig deeper and accept the necessity of systemic change. We may not have time for gradualism.
So summertime is almost over and “the livin hasn’t been easy”. Maybe the cool, crisp days of fall will bring more clarity and the energy we need to deal with “insolvable” problems. In the meantime, my recommendation to all is to prepare yourselves for some rough weather in the months ahead.
P.S. I promise never to use a weather metaphor again!
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 285,000 State employees, retirees and their dependents.
This program aired on August 8, 2008. The audio for this program is not available.