The Massachusetts Model as Whipping Boy for Healthcare Model

[steven johnson]

Massachusetts requires everyone to have health insurance or pay a penalty. While there have been growing pains, the number of people reporting problems paying medical bills and gaining access to care, after falling sharply, has begun to rise again. Massachusetts has yet to figure out is how to slow the rise in medical costs and insurance premiums.

Now Massachusetts is aiming to tackle costs using a system in where groups of doctors and hospitals would receive fixed sums to deliver whatever care a patient needed over the course of a year.

August 09, 2009
Massachusetts's experiment in near universal health care coverage has become a favorite whipping boy for opponents of health care reform. They claim the program is a fiscal disaster and that the whole country will be plunged into a similar disaster if President Obama and Congress's Democratic leaders have their way.
That is an egregious misreading of what is happening in Massachusetts. The state's experience so far suggests that it is more than possible to insure almost all citizens and stay within planned budgets - although it will take great creativity and political will to hold down rising costs so that the program is sustainable.
Three years after the program began, 97 percent of Massachusetts residents have health insurance - by far the highest rate in the nation. That has been achieved without huge increases in state spending.
The Massachusetts Taxpayers Foundation, a non-partisan research group, recently concluded that the cost of achieving near universal coverage "has been relatively modest and well within early projections of how much the state would have to spend to implement reform." That is heartening news given that the major features of the Massachusetts reforms are similar to those under consideration in Washington.


The Massachusetts Model

[nightrain]

1. It's not so pretty in MA--

http://www.bostonherald.com/news/politics/view.bg?articleid=1189479


Health care agency’s payroll bloated
Staff, salary has ballooned since inception
By Hillary Chabot and Joe Dwinell
Thursday, August 6, 2009 - Updated 3d 8h ago



The payroll at the agency steering the state’s controversial universal health care effort has swollen to more than four times its original size in just 18 months - with a top-heavy bureaucracy led by dozens of high-paid managers, newly released records show .

The Commonwealth Health Insurance Connector’s staff and salary explosion - including 17 managers now paid more than $100,000 a year and numerous contracted employees - has continued despite protest from Beacon Hill lawmakers.

“At a minimum, all of the salaries need to be frozen and reviewed with an eye towards cutting them, and there should be a hiring freeze,” said Sen. Mark Montigny (D-New Bedford), vice chairman of the Legislature’s public health committee. “We’re in a crisis. That’s what happens when we’re in a crisis.”

The Massachusetts universal health coverage mandate - the creation of former Gov. Mitt Romney - is being ripped by critics of President Obama’s health care plan as a glaring example of out-of-control costs, jacked-up insurance rates and failed goals.

In a recent letter to the Minnesota congressional delegation, Gov. Tim Pawlenty compared Obama’s plan to the Bay State’s, noting: “That state’s experience should caution Congress against this approach” because “costs have been significantly higher than expected.”

Despite the national spotlight on its first-in-the-nation work, the Connector agency has in just a year and a half larded its bureaucracy with a dozen directors and assistant directors, and 14 bosses with the word “manager” in their titles. It also doled out 3 percent raises this year. The agency has 89 staffers on its payroll and is headed by Executive Director Jon M. Kingsdale, who makes $238,703.

Richard Powers, spokesman for the Connector, defended the salaries, saying they are in line with the employees’ “experience, knowledge and responsibilities.”

“There are people who came here from the private sector who took a cut in pay just to be involved in something that’s cutting edge,” Powers said.

Saying the agency was in “ramp-up mode” when there were only 22 employees in 2007, Powers said they had always projected a roughly 50-member staff.

The Connector has signed up 439,000 newly insured Bay State residents since it was created by the Legislature in 2006. Customers pay between 3.5 to 4.5 percent from their insurance costs for the agency’s salaries, Powers said.

The state, which has struggled with subsidizing the new law, spent $800 million to insure low-income residents last year.

In some cases, the Connector’s titles appear redundant. There is, for example, a chief communication officer, chief information officer, director of public affairs and chief marketing officer - all at six-figure salaries.

“The agency has exceeded my worst expectations. It’s clearly bloated and top-heavy with a number of positions that seem to be expendable,” said David Tuerck of the Beacon Hill Institute, a conservative think tank.

Rick Lord, head of Associated Industries of Massachusetts, who sits on the unpaid board that oversees the Connector, said he would be open to re-examining the higher payroll now that the state has insured all but 2.6 percent of the population. “It’s always good to revisit these issues on some kind of regular basis,” Lord said.

The Connector is just one of 52 quasi-state agencies under review by Gov. Deval Patrick, who announced the study after his disastrous push to install Sen. Marian Walsh as the $175,000 assistant director of the Health and Education Facilities Authority.

“The very life of these quasis should be in jeopardy,” said Montigny. “Their only purpose is to provide inflated salaries and bury patronage hires, and they’re generally less accountable and less effective.”

[dflprincess]

2. Per capita payments have been tried with private insurers

they don't work and they can affect the quality of care.