Reformers, pay more attention to Massachusetts

Those of you who read FierceHealthcare regularly know that the jury is still out on how valuable Massachusetts health reforms have been. That being said, there's early data suggesting what problems the Massachusetts model has, and it has definite implications for national health reform.

The thing is, I don't get the sense that legislators on Capitol Hill are spending a lot of time thinking through the only working health reform model we've got. That's very troubling, considering that we're looking at spending hundreds of billions of dollars here. I bet some of you can't get a $1,000 travel budget approved these days without digging up more data than they have.

So what's up in Massachusetts? While there's no doubt that more people have insurance there than ever before, healthcare costs continue to rise, ethnic disparities remain and there's no clear connection between money spent and outcomes delivered, analysts say [1]. 

What's more, people are starting to wait in line for care [2], especially for primary care appointments. In fact, the mean time for getting a first appointment with a physician in Boston was 49.6 days, the longest in the country, according to a recent survey [3] by Merritt Hawkins and Associates. This doesn't help people get well, exactly, does it?

Another interesting note is that Massachusetts offers one form of "public option" which could conceivably serve as a model for the one being promoted by President Obama. As of January 1, 2009, this public option, known as Commonwealth Care, had enrolled over low- and moderate-income 163,000 adults, who pay little or nothing for private health insurance. However, reimbursement rates for Commonwealth Care have proved to be low--and rules for physicians who participate haven't been popular--so getting appointment has been even harder for these folks.

While the dynamics in a single state are not necessarily the same as those that would exist nation-wide, they offer important reminders:

* It doesn't make sense to hand out health insurance to everyone without increasing provider capacity somehow. (Yes, that's a stumper, particularly if you don't intend to pay them very well.)

* It's all well and good to subsidize health coverage, but it's probably a good idea to impose more quality controls on what you're buying.

* Private health plans don't have much of an incentive to lower health costs, so it may not pay to rely on them if you're trying to squeeze costs out of the system. (OK, that one may upset some of you, so go ahead and let fly.)

Now, Congressfolks, it's up to you. Does this little Massachusetts overview give you pause? Or are you just psyched that the state managed to get these reforms enacted and eager to do something that seems correct? As an American taxpayer, I dearly hope it's the former. - Anne [4]