'Let's Try the Road Not Taken' by Dolores Mitchell

My good friend Jim Roosevelt — who also happens to be the CEO of Tufts Health Plan, one of the GIC’s larger plans — in his blog last Friday described a White House Press event on health reform that he had attended and pointed out that the much admired Massachusetts HealthCare reform program does not include a public option. He suggested that perhaps the country doesn’t need one either. Well, maybe. I’m not particularly interested in getting into a debate with Jim or any of his colleagues from the other five health plans we offer and I most definitely do not want to detract from the success of the Mass HealthCare Reform Act, but we don’t necessarily need to clone all of its features at the federal level. I understand that the private health insurance companies’ Trade Associations, the Massachusetts Association of Health Plans and at the national level, America’s Health Insurance Plans are officially opposed to the prospect of competing with a public plan. They say it will be an unfair competition, and they all assert that they can do the job better, especially if the government provides money to subsidize low income citizens who are currently priced out of their market — 47 million of them. I could concede the point that the playing field might not be level if AHIP acknowledged that even with the best of intentions, they have been unable to control the costs of health care. This is not to say that the challenge is an easy one — it isn’t.

Between an aging population, new technology, wildly escalating pharmacy costs, and a culture that favors choice over price, especially when someone else is paying most of the price. Nevertheless, the sad truth is that even Massachusetts’ excellent and largely non-profit managed care companies have never recovered from the anti-HMO onslaught of the mid-90’s and have not succeeded in their efforts to keep costs under control while simultaneously keeping both providers and enrollees happy — thus proving, once more, that if you try to please everyone you may end up pleasing no one.

The current system has had 15 years or more since the early 90’s, when rates actually went down, to prove that a less managed system could provide quality care to all Americans at affordable costs. Perhaps it is time to try a different approach.

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.