LISTEN LIVE: All Things Considered
LISTEN LIVE: All Things Considered


"Uniting to Avert a Massachusetts Health Care Train Wreck" by Michael V. Sack

This article is more than 13 years old.

For Massachusetts' hospitals, I fear the light at the end of the tunnel may be an oncoming train.

The impact of the overall state fiscal crisis and Governor Deval Patrick's emergency "9C" cuts is just beginning to be felt, and already the outlook for health and human services is grim. Governor Patrick had no easy choices, and tough cost cutting decisions absolutely had to be made. But hospitals and other health providers are hit especially hard, not only with a disproportionate share of the cutbacks themselves but also with losses of federal matching funds due to reductions in promised Medicaid payments.

Already several hospitals have been forced to lay off staff, and many other are delaying or abandoning planned investments in the facilities' physical plants and infrastructure. There are dire warnings within the legislature that we may face yet another round of cuts when it reconvenes in January.

As the economy continues to unravel, I fear it could trigger an "every entity for itself" mentality that would spell disaster for the entire health care reform effort. One of the leading of health care reform in Massachusetts has been its collaborative nature. Hospitals and other providers with very different patient populations, market shares and agendas have joined together, along with insurers, businesses and the government to reach compromise. Everyone has made substantial sacrifices for the greater good.

Now, important health programs with long-standing track records and high utilization are disappearing, just as demand becomes even greater.

I have expressed this concern informally with other hospital CEOs, and there is a widespread sense that key programs in areas such as behavioral health will soon close, not because there is insufficient utilization, but because costs can't be met.

If the various members of the health care community give in to this sort of individual response, we will collectively - and deservedly - be cast in a negative public light. Our relationships with the state Legislature and other government entities will fray. It could wipe out the ground-breaking advances we've all worked so hard to achieve.

The fiscal crisis has slowed our momentum on health care reform, but not our resolve. It's clear that we cannot afford to keep up our earlier pace, but the further fiscal situation raises a particularly tough question: Is our health care reform effort affordable at all? I believe that while we face tremendous challenges affording health care reform, we can afford to backslide even less.

As more information comes out about the budget cuts and their consequences for hospitals and other health care providers, we are once again hearing from different sectors of the Massachusetts health care community - this time in support of making a vociferous and unified effort to secure additional Federal Medical Assistance Percentage (FMAP) funds for Massachusetts providers, specifically to address the continued payment inequities exacerbated by the recent state cutbacks. This soon needs to become a unanimous rallying cry.

We cannot simply cut our way out of the challenges we face, nor can we focus exclusively on individual survival. We have to keep the commitments of reform to expand coverage and pay for it fairly. We have to reconsider cuts that turn away federal funds. We have to look at limiting investing in system improvements that will lead to better cost management. In the immediate future, the best way to keep these commitments moving forward is to join forces to obtain increased FMAP funding, and using it to mitigate some of the state cuts and support needed investments.

Working together, the disparate members of Massachusetts' health care community can get the state's reform efforts back on a straight and clear path.

Michael V. Sack
President and CEO, Hallmark Health

This program aired on November 19, 2008. The audio for this program is not available.