Romneycare Rationing

From the diaries by Erick

According to this Boston Globe article, the good ole Commonwealth of Mass is trying to save its universal health care plan — by doing pretty much the same sorts of things that liberals whine that HMOs and private insurance plans do.

The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers.

But a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care – an issue some providers say the commission and the Patrick administration have glossed over.

So let’s see… Members of the Kennedy family will be able to get all the health care they want at any place of their choosing, and this will get some of the riff-raff out of their way. But wait, it’s really worse than that if you read on.

A state commission recommended in July that insurers largely scrap the current fee-for-service system – in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit – and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.

It doesn’t take a genius to figure out what will result from this. If a doctor or a facility is going to receive a set amount per person per year regardless of the person’s medical needs, specialist disciplines will get wiped out and all providers will be looking to do as little as possible for each patient, since every extra test or procedure is taking money out of their own pockets.

The release of the report sparked a lobbying campaign by Massachusetts health care executives, who are urging Governor Deval Patrick’s administration and state legislators to move cautiously because they fear a new payment system could bankrupt some providers and compromise patient care. Many changes recommended by the commission would have to be approved by the Legislature before being put in place.

As I was saying…

But Sarah Iselin, head of the state Division of Health Care Finance and Policy and cochair of the payment commission, said the panel understood the importance of addressing the effect of its recommendations on patient choice, but “felt these issues could be figured out’’ later by a board that would be created to oversee the transition to a new payment system.

Amazing – they punt on the big question until it’s too late. I guess this is the Mass equivalent of Washington’s voting a blank sheet of paper into law and then filling in the details later.

The commission recommended that all residents choose a primary care doctor, because many patients will listen to their doctor’s recommendations about where to get care, she said. Under global payments, those doctors would have an incentive to refer patients within their organization. And, she said, educating patients about low-cost, high-quality providers also will play a major role, and may preclude the need for forced restrictions on choice. “Over time, patients may very well be inclined to go there all by themselves,’’ Iselin said.

And if the patients don’t voluntarily give up their current freedom of choice, it once again doesn’t take a genius to know that they’ll figure out a way to force on the poor and middle class.