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Mass HCR Plan 2004

Mass HCR Plan 2004

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Published by Andrew Kaczynski

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Published by: Andrew Kaczynski on Apr 23, 2012
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Health Care Reform:
Covering the CommonwealthʼsUninsured Residents
 A Model for the Purpose of Discussion Executive Ofce of Health and Human Services Ronald Preston, Secretary
May 3, 2004
The numbers herein are necessarily estimates. Real numbers can come only once weʼre closer tosetting up the program. However, in developing these estimates, we were conservative. Both themoney the initiative will take and the fees needed to generate this money are deliberately high.Timing: If we can work with interested parties over the summer, and the General Court starts itsdeliberations in the fall and legislates a program in the spring, we can have the program up bythe summer of 2006.
Introduction 1
Everyone Should Have Health Insurance
Providing access to health insurance for everyone is an important goal. It is important forthe well being of persons who do not now have health insurance. It is important to thecompetitiveness of our businesses, to health care cost containment, and to the efciency andeffectiveness of our health care system. It is important to the comity of the Commonwealth.Being without health insurance is a hardship for all but the very wealthy. For any complex need,health care is expensive. If one cannot pay out of pocket, many health providers and services arebeyond reach. One is mostly limited to hospitals, which are often inconvenient and not the bestplace for primary care or even some specialty care. If one is lucky, a community health centeris nearby. But these are often very busy places. Studies show that uninsured people use fewerhealth services, and more often wait to seek care until small, less expensive ailments becomelife-threatening, more expensive ones. For most people, when calamity comes, being withouthealth insurance raises the specter of nancial ruin and endless problems getting the right care.Being without health insurance causes great anxiety.The problems of the uninsured do not belong just to them. Everyone else is also impacted. First,there are health concerns. If oneʼs tuberculosis goes untreated, that endangers everyone. If onebecomes disabled through want of care, one needs the help of others. Then, there are moneyconcerns. Everyone else pays for the care the uninsured do receive. These costs are shifted ontoproviders and ultimately onto payers. Employers pay more to cover their employees. Insuredindividuals pay more for their coverage. In the Commonwealth, insurers, hospitals and the statepay more for the Uncompensated Care Pool.This cost shifting is fundamentally unfair. Employers who cover their workers must also coverthe “free care” provided to the workers of employers who do not offer coverage. Individualsmust not only pay for their own coverage, they must also pay higher premiums to subsidize thecare of the uninsured.Cost shifting obscures the true costs of care. This matters because clarity is essential torationalizing the market for health care. Health care is stupendously expensive, and relentlesslybecoming more so. Medical advances that everyone wants drive most of the increase in costs.But much of it is also driven by medical errors, redundant or unnecessary tests and treatments,and administrative disarray. More efciency is needed. A central means to this efciency iseffective bargaining between the buyers and the providers of care. Payers cannot negotiatetransparently with providers when costs for the uninsured are buried in the numbers. Getting

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