Three years after mandating that residents get health insurance and requiring employers, insurers and taxpayers to chip in, Massachusetts has yet to control soaring costs that are eating up half its budget. So it’s considering an equally radical idea: changing the way doctors and hospitals are paid to reward results.
As Washington wrestles with the idea of overhauling the nation’s health care system, the Bay State offers an object lesson in how to do it in stages. It’s an approach favored by state officials but rejected by the Obama administration, which is intent on addressing coverage, cost and quality all at once.
Massachusetts dealt with coverage first: just 2.6% of state residents remain uninsured, compared with more than 15% nationally. That’s due in part to the 2006 law, which said most residents must get insurance, most employers must help provide it, and most taxpayers must help pay for it.
[…]
Using Massachusetts as a partial model, President Obama is trying to tackle even more difficult coverage, cost and quality problems all at once. The president seeks to extend insurance to up to 46 million people without it. At the same time, he wants to slow the growth of Medicare and Medicaid, now projected to rise from 5% of the nation’s economy to more than 17% by 2080.Still, Massachusetts offers lessons for national policymakers as they debate the biggest change in health care delivery since Medicare and Medicaid were created nearly a half century ago:
Read the article to learn what they’re doing.
Reform will only work with reasonable rationing. My sister-in-laws mother is 85, and not in great shape. They’re installing a port today to deliver chemo for peritoneal cancer. It’s advance, but they scheduled her for 6 weeks of chemo. I doubt she’ll survive the chemo, and will likely stop it because of sickness.
My Dad refused chemo for stage IV lung cancer. The MD told him it was a wise choice, and they would keep him comfortable. He died two weeks later, in no pain with a morphine/ativan mix. The chemo treatment would have cost $5K each, with five or six treatments. I’m sure he would have suffered greatly, and the end would have been worse. It wasn’t the money, Dad had great insurance, but he recognized it was his time, and he didn’t want to spend the last bit vomiting and hurting.
#1–RTaylor==kudo’s to your father, best of luck to SIL mother–may she get what she hopes for.
The HARD DECISIONS are being avoided here, by Obama, and most commentators. Sometimes issues have “basic parameters” that limit or set the range of outcomes you will have. Healthcare is very much governed by the delivery model it is provided under. The end user disconnected from cost/price/payment. Intermediaries motivated to provide unnecessary services. Services provided on a “for-profit” model. Sick model rather than a health model.
So, until most if not all of these and other “basic issues” are addressed, healthcare inflation will continue disproportionately.
My outline: get rid of private insurance and go with single payer. This alone will pay for all other contemplated changes to the system. Legislate a common sense RATIONED set of benefits. Those wanting more can pay for it privately out of pocket or by additional insurance.
And so forth.
and part and parcel: legalize and tax ALL DRUGS and prostitution. If we are going to break with precedent and be practical, lets throw in all related issues.
Others?
1. Jailing non violent law breakers?
2. Not deporting illegal aliens when ever discovered.
3. Maintaining terrorist watch list as currently done.
4. Airport Security. (Locking pilot door is all that was needed.)
More?
#3: How about taxing churches?
#4–Uncle Dave. As in EVERYTHING, there are pro’s and con’s to every decision/program/approach/theory/rules that are applied.
Originally, the argument was that if religious activities are taxed, then tax enforcement would involve and intertwine the state too much into church affairs. The no-tax position is “all about” the separation of religion and state sponsorship.
The tradeoff was that churches were not supposed to be cover/subterfuge for political activity. Traditionally, the state has chosen not to enforce this part of the deal.
Pro’s and con’s.
What I find interesting is they HYPOCRISY of activist churches. Being anti-god myself, still, seems to me that Churches to be worthy of their missions should be as political as their various missions inherently embrace. The hypocrisy is claiming to be religious, being engaged in politics (as they SHOULD BE), but then claiming tax free status.
NOTHING PROHIBITS a church from engaging in politics nor in operating as a for profit/taxable institution==except Human Greed.
So, whether or not churches are taxed is a secondary issue in my mind.
I should add to the historical context, the starting not ending context, that when originally considered and implemented, churches weren’t the money grubbing fradulent ponzi schemes too many of them are today. This means taxing churches from a government revenue viewpoint was about non-existent when the rules were passed, but variably very relevant today.
However, from the start and now, churches have been organs of social change–ie, politics.
To THAT end, yes I do think “rules” should be enforced or changed. Only way that could happen would be for a special department of religious/tax enforcement got implemented. As with so many malum prohibitum laws, makes me wonder which would be worse–the violation of law, or the enforcement of it and how to ever write a law that would/could be enforced?
I can really see everybody in California getting health insurance. Sure. Right after the get a social security number. What about the millions of people who are here illegally? Who is supposed to pay for THEIR medical insurance? Not me, I think.
Bobo. You want to tax the rest of the non profits? How about the Red Cross and Salvation Army? That should bring in some money. Obama favors less charitable giving or at least doing away for tax write offs for same which amounts to the same thing.
For less than 250 billion you could extend basic health service to everybody in America that can’t afford to pay it and require those who can and aren’t buying insurance to do so. The later is a major hunk of the problem.
Why the bleep are we about to pay a trillion and a half or more for less available medical care, lower life expectancy, and care which based on the English modal is going to suck?
My elderly mother needed a heart ablasion to control her heart. She was past 80 and in poor health. Obama care would have let her die. This amounted to go one day, have the surgery, and go home the next. She is still in fragile health but she is home and still ticking three years later.
You can take your Obama care and stick it where the sun doesn’t shine. If it passes I hope you die from it. In fact the odds are outstanding that somebody in you family will die sooner.
Tell me again why we should pay more for less?
Tennessee went through the same thing 10 years ago with TennCare. It was a financial disaster.
#8–do-ill==you are farcically wrong on just about every point you make. I know it would only confuse you furthr if I methodically responded to each point you make, so:
Pick whatever single issue you want an education on and repost. I need a good laugh to continue the day.
When I was a newly licensed 16 year old driver, I couldn’t find anyone to insure me. So, I was put into the assigned risk pool. The next company in line had to take me and charge a fee set by the state. Would it be so hard to do with medical insurance? Those with some ability to pay would pay premiums determined by the gov’t. Those with no ability to pay would be assigned to medicare/medicaid.
Problem solved.
I know there would be a lot of problems setting it up but would those problems be any greater than what Obamacare will bring?
the only way this is going to work.
1. gov takes over distribution of medical supplies and Equipment. NOT the 4-6 companies that run around selling CRAP at outrageous prices.
2. control of medical spending. as per #1, each hospital and rural clinic NEEDS specific goods and equipment. Sending samples from a rural clinic to be tested 200 miles away, ISNT A GOOD THING.
3. JUST give the doctors WAGES.. and require them to work ??? days per year, as an employee.
4. NO tax to Doctors and hospitals, The gov should buy the LAND for the clinics, and as long as the Doctors are working, there is NO RENT.
13,
CORRECT..
another middle man. the HMO..
SCREW them and go direct to the hospitals and make a DEAL.
#13: And that is why we have to find a solution that is not dependent on insurance companies (as is MA’s). From what I can see, insurance companies only exist to leech 30% of our medical $s. What other purpose do they currently perform? They are the biggest, baddest bureaucracy in healthcare.
I hate to say it,
but the best use/abuse is in medicare/medicaid.
They have most of the bumps cleaned up. BUT they dont have the power to clean up MORE of their problems. The main one is the regulations that have been PUT UPON them from the gov.
I wonder what Medicare would say about MAKING a new better system, and how to run it.