Greetings from a medical office in Massachusetts, democracy’s laboratory!
A bill that will adjust virtually every piece of the state’s health care system is now law. Gov. Deval Patrick signed the legislation Monday morning in a packed State House hall.
“Massachusetts has been a model for access to health care,” Patrick reminded the crowd. Now, “we become the first to crack the code on costs.”
Pardon me while I take a steadying sip of my coffee… Righto! On we go.
“It’s a very big deal,” said Ralph de la Torre, CEO at Steward Health Care, the state’s second-largest hospital network. “We’re starting to deal with the second part of health care reform. The first part was increasing access and expanding coverage to everybody. Now the second part is figuring out how to contain costs so that it doesn’t impact businesses and society in general. It’s a clear move in the right direction.”
I almost agree with all of that. While I, like almost every American, am still not entirely sure how the Affordable Care Act is going to work in practice, I think the goal of increased access to healthcare is eminently laudable. I want access to be as universal as possible. And increased access without efforts at cost containment will only worsen the already unsustainable morass of healthcare expenditures in this country, so I am also quite pleased to see elected officials making an effort to address that part of healthcare reform as well. My only qualm regards that bit about “so that it doesn’t impact businesses and society in general.”
As partner in a business that provides healthcare, I have rather a significant stake in how this plays out. And I would love to believe that somehow costs can be contained in such a way that our bottom line doesn’t take a hit. Indeed, I am reasonably hopeful that expenses can be reigned in in a way that doesn’t hurt practices like mine. But the notion that cost containment can be enacted without society in general being impacted requires rather more fairy dust than I am willing to clap my hands for.
Someone somewhere is going to feel the cut somehow.
For my part, I’ve already observed that the hospitals where I am on staff are taking the issue seriously. Boston Children’s is trying to get out in front, which I think is smart. I have absolutely zero doubt that there are many, many areas where costs have run amok with no benefit to anyone and in which cuts are totally appropriate. But I am skeptical that all the cost containment that needs to be done can be done without anyone actually feeling it, or having to do with less than they want.
None of this is to say that I do not support Gov. Patrick’s new law. Given the broad coalition of groups that turned out in support when it was signed yesterday and what one might reasonably surmise about various factions getting at least some of what they want, I think it’s probably a step in the right direction. And sooner or later laws of this kind will be unavoidable, so better to start now. I can’t really argue with this:
The law says health care costs must stop growing faster than other household and business expenses, as of next year. While many hospitals and physicians say that’s not realistic, Lora Pellegrini, president of the Massachusetts Association of Health Plans, says having the target in place is important.
“Folks know there’s a microscope on health care costs,” she said. “So if somebody misbehaves and they’re trying to look for high rates and they’re unjustified, I think there’s a very public conversation that’s going on about those things.”
It’s hard to imagine the president of that group showing up to support a law that would gut healthcare reimbursement rates. Certainly it bears scrutiny if a medical center ups its rates for no reason than padding its bottom line, and if this law keeps that in check then I have a hard time faulting it.
All of that said, however, I have no choice but to pay close attention to how this law actually works in the coming months and years. My own bottom line could be affected, and I don’t yet know how (or if) the ramifications will touch on my practice and my patients. But I promise to keep you posted.