Health Care Reform FAQs
How can we possibly afford significant health care reform?
Wouldn’t such changes to the health care system result in higher
taxes or insurance premiums?
Massachusetts already spends more per capita on medical care than nearly
anyplace else on earth. The trouble is, a very large proportion of the
dollars already being paid are siphoned away from patient care and into
wasteful bureaucracy and paperwork, or dividends for shareholders of for-profit
insurance companies.
We propose a "90/10" rule will ensure that much more of the
state’s health care dollar is actually spent on health care.
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Doesn’t Medicaid already take care of the un-insured?
There are approximately 350,000 people in Massachusetts with no health
insurance. Medicaid covers the poorest citizens of the Commonwealth; the
un-insured are more likely to be working people whose jobs don’t
provide any health insurance but who can’t qualify for Medicaid.
More and more, the un-insured are also middle-class people who suddenly
find themselves without health insurance because of job changes or cutbacks,
as well as younger workers just starting out in their careers.
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Isn’t the marketplace the best way to sort out the problems in
health care?
The marketplace may be the best way to deal with cars or groceries or
phone service, but it has proven to be a disaster in health care. The
care of sick, vulnerable people is a particularly complex and unique function
in a society, for which marketplace solutions have been found to work
poorly.
The economic near-death experience of Harvard-Pilgrim Health Care, the
state’s largest HMO, and the very vulnerable state of other health
plans and some of our finest teaching hospitals are proof of the damage
that "marketplace medicine" can do if left unchecked.
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Why such a big emphasis on keeping for-profit health care companies
out of Massachusetts?
For-profit health care companies by their very nature are primarily accountable
to their stockholders; their success is measured by how big a piece of
the insurance dollar they can siphon away from patient care (what they
refer to as the "medical loss ratio") and pass along to their
investors.
We believe that doctors, nurses, and other health care professionals
should be primarily accountable to the sick people we serve, not to managers
or shareholders.
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If we reform our health care system, won’t it just mean a return
to the bad old days when doctors and hospitals got to charge whatever
they want, do unnecessary tests and procedures, and raise medical costs
through the roof?
Certainly not. In order to contain costs, we propose that medical expenditures
in Massachusetts rise at a rate no faster than that seen in the rest of
the country. Nearly everyone realizes that the "old days" of
unbridled fee-for-service medicine had major problems and do not represent
a workable solution for the future.
Decisions about what care a patient gets should be based on the best
available evidence from medical studies, and open discussion between doctors
and patients – and not on the financial interests of insurance companies,
employers, HMOs, or health care providers. We support a road map to the
future, not to the past.
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Will such changes bring a consolidated financing "single-payer"
system to Massachusetts?
Not necessarily, but it absolutely ought to be considered and debated.
Our vision for health reform does not prescribe any one solution to the
state’s health care crisis. Instead, it sets forth certain principles
of access, patient rights, quality and affordability--achieved in part
by the requirement that at least 90% of health care dollars actaully be
spent health care, reducing the amount spent on administration and marketing.
There are several ways such solutions could be implemented. What is needed
is to establish a mechanism for public debate on the best way to achieve
the goals described above, and set out a means for that debate to be translated
into policy once consensus is achieved, with mandated deadlines for these
changes to occur.
We believe that in a democracy, the best way to develop policy on such
a vital issue is through inclusive and open discussions and thorough consideration
of all the options – not behind the closed doors of corporate boardrooms,
government regulators, or un-accountable insurance companies.
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Will health care reform eliminate the state’s HMOs?
Health reform will put important curbs in place to control some of the
most unpopular excesses of the HMO industry. These companies should be
able to adapt to a world of greater patient autonomy, reduced bureaucracy,
and diminished paperwork and middle management. They will survive and
provide better health care in the process.
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Didn’t the Managed Care Act passed by the legislature over the
summer of 2000 take care of all these problems?
Definitely not. The hastily put-together bill was a clear response to
the presence of Question 5 on the 2000 ballot. On the patients’ right
issue, it resurrected a bill that had been languishing in committees on
Beacon Hill for three years and gone nowhere.
This does represent a modest but useful step forward in this area. However,
the Beacon Hill plan does nothing to guarantee access to health care for
everyone. Instead, it calls upon the legislature to form a committee to
hire a consultant to write a report. That’s no guarantee of anything.
By contrast, we propose a law that every citizen of Massachusetts be guaranteed
access to health care by an explicit deadline. No ifs, ands, or buts.
Similarly, the new state law leaves the door wide open to for-profit
control of Massachusetts’ financially vulnerable hospitals and HMOs,
a prospect that has out-of-state businesses salivating. It even provides
a road map describing how such acquisitions can be done legally. By contrast,
we propose a clear moratorium on all such takeovers.
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Isn’t all this rather naïve, unrealistic, and ultimately
unworkable?
Health reform proponents include large numbers of front-line doctors,
nurses, and other health workers who intimately understand what real-world
patient care is about and what it requires – far better than some
of the management "experts" who have driven the health care
system so deeply into crisis. It also includes some of the state’s
best thinkers on public health and health policy, as well as patients,
who often grasp these issues better than the professionals do. Change
is possible. Building the political will and grassroots power to demand
these changes are what is needed.
Have more questions about health care reform?
Feel free to contact us.
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