Last week, after Governor Patrick’s state of the state address, the Boston Globe ran a story by Alice Dembner on the projected increases in costs of the Massachusetts universal health care coverage law. A Healthy Blog deconstructs the math, concluding that the costs are not as high as the Globe would have us think.
Without getting into the numbers here, the key point for me in all this is that improving health care for all requires improving several things: access, quality and cost. It’s a three-legged stool; can’t have one without the others. However, the political reality is that you can’t have it all at once. As I (and plenty of others . . . see, e.g., Speaker Sal DiMasi’s recent post at Commonhealth) have been saying for a while now, the only way to achieve health care reform — in Massachusetts or nationally — is incrementalism, baby.
Here in the former people’s republic of Massachusetts, we’ve taken the first steps towards assuring universal access (in terms of coverage; access in terms of actually having primary care providers available is a whole other story). The other "legs" will come — the quality leg is well underway and cost will ultimately be addressed in myriad ways, including reductions in cost thanks to access to primary care as well as paradigm shifts in reimbursement such as the recently-announced Blue Cross Blue Shield of Massachusetts experiment.
The question remains: Will everyone remain patient enough to let this experiment play itself out? See Boston ERISA blogger Stephen Rosenberg’s thoughts about the Globe story and ERISA pre-emption issues; I’ve written before about the ERISA pre-emption question as well. Thus far, the coalition that brought this law into being does not seem likely to break up and result in such a challenge being raised.
Paul Levy says
The quality leg is really not well underway. It is moving at the speed of molasses in most of the industry. I hope this will change. It is an essential part of cost containment — and of course, of saving lives.
David Harlow says
You are way out front on this piece. (Other readers out there, see http://runningahospital.blogspot.com/2008/01/aspirations-for-bidmc-and-bidneedham.html ). Other folks will get there eventually — on their own or thanks to the emerging state requirements under Chapter 58.