Massachusetts Took The Right Approach To Reform By Sequencing Enrollment And Cost Containment

 

Massachusetts Health Connector Executive Director Jon Kingsdale, in a perspective published recently in Health Affairs, says that state policymakers were prudent in 2006 when they opted to sequence the enrollment and cost containment phases of its landmark healthcare reform legislation.

With more than 430,000 newly enrolled and the lowest rate of uninsured in the country at 2.6 percent, Kingsdale said state leaders have always known that the moral imperative to cover nearly everyone leads to a confrontation with costs. He describes it as the second phase of Massachusetts healthcare reform and notes it is well under way.

Writing for the Health Affairs web site, Kingsdale said that trying to anticipate and address related cost, quality and access issues simultaneously “would be more than Herculean – it would by Sisyphean; that is, proponents would be doomed to a cycle of Herculean effort, followed by failure, then a renewed attempt at reform, ad infinitum.”

Kingsdale pointed out that the country’s health sector is now 150 times larger than England’s when it enacted universal coverage and nationalized its delivery system. With the health sector estimated to be 17.6 percent of the estimated U.S. gross domestic product, it is 1.5 times bigger than manufacturing, four times the size of construction or transportation and fifteen times larger than agricultural production.

“It is incredibly fragmented and complex, driven by for-profit, nonprofit, academic, and government providers and payers,” Kingsdale wrote. “And it is extremely personal, touching almost every voter. Reforming any element of American health is a challenge. Reforming it all at once is overwhelming.”

Noting that first expanding enrollment actually helps push policymakers to confront costs, Kingsdale said that by starting with the individual mandate, supported by mandatory employer contributions and public subsidies, Massachusetts took a giant step and positioned reform for the next steps.

He pointed out that in 2008, the state legislature introduced reforms aimed at cost, including support for automating medical records and information sharing and restrictions on marketing by drug and device makers. Governor Deval Patrick has called for bold action to contain costs and a payment reform commission is expected to recommend to him next month to move the predominant basis for reimbursing providers from fee-for-service to “global budgets.”

“The debate has now been joined, and leading interest groups, the media and an increasing share of the public seem to understand that the moral path to expanding coverage eventually leads to cost containment,” Kingsdale wrote.

“Its ( Massachusetts’) early success suggests sequencing reforms, providing adequate resources and flexibility for a long implementation, and eventually forcing a confrontation on costs. If comprehensive reform is a marathon, not a sprint, the nation will need a strategy for pacing itself at the start, maintaining momentum and finishing strong, he concluded”

The entire perspective can found on the Health Affairs web site at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w588.

-Adapted from “ Massachusetts Took The Right Approach To Reform By Sequencing Enrollment And Cost Containment; Kingsdale Provides Perspective in ‘Health Affairs’”.

5/09