Deval Patrick's health care plan

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http://www.devalpatrick.com/issues_health.cfm

Moving Massachusetts Forward- Easing the Cost of and Broadening Access to Health Care

My Vision for Our Future

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I see a Commonwealth where no one needs to be afraid of being without safe, affordable, high quality health care, or being financially ruined by a health problem. I want health care for every man, woman and child in Massachusetts that is

Accessible
Affordable
Portable
Safe
Patient-centered, and
As effective as modern science can make it.

I see health care as a common good - like clean air, safe streets and effective education - and so I believe that government has a role to play in assuring that the conditions exist for the health care system we all want. The "market" alone is just not enough. At a minimum, the Commonwealth must assure that everyone who faces a medical catastrophe has covered care. Illness or injury should not cause financial ruin.

That is not what we have now. Workers and employers in Massachusetts, both private and public, and all of our citizens with disabilities or chronic illnesses, have seen their healthcare costs spiral over the past decade - often at three times the rate of inflation. In my administration, consumers, health professionals, health insurers and other stakeholders will work with the state legislature to assure that premiums are held in check. Doctors, nurses and other health care professionals will be compensated at competitive rates to help retain the best talent. In the Massachusetts I envision, affordability cannot and will not be the enemy of quality care. We will have both.

I envision Massachusetts as a model for public health stewardship, a state that gets healthy and stays healthy -- emphasizing disease prevention and wellness programs that help reduce the total cost of illness, injury and disability. We will have effective programs to assure childhood immunizations, and to address drug and alcohol addiction, mental health needs, gun safety and other violence prevention, and HIV/AIDS screening, treatment and prevention. We will move quickly to build an active partnership with private interests and the public schools to address obesity and other issues related to healthy choices by kids.

We can afford the system I envision. Massachusetts spends more on health care today than many other states, and over twice as much as other Western nations with better outcomes. We have the resources we need, if we have the discipline to take the administrative waste out, to integrate care for people with chronic illness, to buy smart, to modernize our information technologies, and to act to prevent diseases at the earliest possible stages. A high quality, safe, reliable and rational system of care can offer all Massachusetts residents what they want and deserve - health care that is always there, that always gets the job done right, at a price we can afford, with no one left out.

The Current Reality

Today, too many of our fellow residents live without health insurance, or fear they will lose the insurance they have. Between 500,000 and 750,000 fellow Massachusetts citizens have no health insurance. Most of them are young; most of them are working full-time. Those whose employers do not offer health insurance benefits can get insurance only by purchasing individual coverage and only the wealthiest among them can afford such insurance. For too many, routine health care is an expensive luxury, rather than an affordable necessity.

People without adequate health insurance often neglect health problems in their early stages until they become too serious to ignore. By then, the uninsured must seek emergency care, which is significantly more expensive than the care they should have received initially. Massachusetts pays for that care through a special fund -- called the Uncompensated Care Pool -- which levies assessments on hospitals and insurers. Those costs are passed on to people who have insurance. In other words, people who have insurance already fund health care for people without insurance -- but in the most inefficient, inequitable and costly way imaginable. The insured foot the bill through higher co-pays for doctor's visits or prescription drugs, higher deductibles for hospitalization, and more restrictions on care.

To make matters worse, many people who have employer-sponsored health insurance discover that their coverage is inadequate. It doesn't meet the cost of the most serious conditions, often and it often doesn't cover conditions that can cause considerable pain and or suffering. So, even people who have insurance have every reason to fear today the prospect of a financial catastrophe brought on by a medical catastrophe. Nearly half of all personal bankruptcies in America are the result of unpaid medical expenses.

Even as health insurance benefits become fewer, we are paying more for them. Premiums continue to increase annually at double-digit rates, far exceeding the rate of increase in the cost of living. For people recovering from a more serious condition, insurance rate increases of 60 percent or more in a single year are not uncommon. Overall, we in the United States spend 50% more for health care than the next most expensive Western nations, but we have worse health outcomes and are less satisfied with our health care system.

Meanwhile, doctors, nurses and other health care professionals are working harder and harder. They are compelled to spend less and less time with individual patients, and are constrained by unreasonable rules and blind reviews to prescribe or not to prescribe certain medications or treatments. They are reeling under a crushing burden of paperwork involved in seeking reimbursement for their services or in transferring records between practitioners or between practitioners and insurance companies. This paper bureaucracy robs them of time with their patients, and claims 30 cents of every dollar spent in the system. (By contrast, administrative costs for Medicare account for less than a third of this amount.)

Prescription drug costs account for a rapidly growing share of total health expenditures. For that reason, the legislature in 1999 gave the governor full authority to explore prescription drug cost controls. Yet the Romney/Healey administration has done nothing to negotiate better rates for prescription drugs.

In our State, as all over America, race and wealth still strongly predict both wellness and access to care for both insured and uninsured people. Racial and socio-economic gaps in health status and outcomes are large and unconscionable. They are not inevitable.

We under-invest in prevention. The Romney/Healey administration has slashed spending on preventive programs by nearly 30% after inflation. This is penny-wise and pound foolish. Eliminating preventive measures ends up costing the State far more later when minor complaints or hidden diseases become more serious ailments.

Closing the Gap

Health care reform in Massachusetts should have two primary goals: extending coverage for high quality care to all and controlling costs. We can do both. In that spirit, and working with all affected stakeholders, I will take the following initial steps:

Expand Affordable Care. As governor I will work with the legislature to enact the Health Access and Affordability Act, a credible, achievable means to bring immediate progress. Through a combination of changes in the eligibility requirements of MassHealth (Medicaid) and reasonable assessments from employers who do not provide health insurance, the plan substantially expands access to affordable health care to Massachusetts residents.

Finance Catastrophic Coverage. No one should have to choose between health care and bankruptcy. To relieve the anxiety for individuals and the burden on small businesses, the State will guarantee catastrophic coverage for everyone in the Commonwealth who is not already covered by Medicare or Medicaid. By spreading these typically high costs over the largest possible pool of participants, and consolidating the many separate reserves now maintained for this care into a single larger one, per-person premiums will be reduced significantly for both employers and employees.

Cut Prescription Drug Prices. Using existing but ignored authority, I will reduce the cost of prescription drugs through negotiated bulk purchases and the development of new channels of supply. It is the duty of the Commonwealth to act in the financial interests of the people.

Modernizing Patient Records Management. We will modernize information systems in Massachusetts health care, using technology to reduce the administrative complexity and cost of the current system. Working in partnership with medical practitioners, all medical records for Massachusetts residents will be supported on a secure, confidential electronic system accessible to patients and under their firm control, so that medical information can be transferred instantly, with the patient's permission, among necessary practitioners. This use of technology will help further reduce the cost and the hassle of navigating through the health care system. The information system I envision will also help patients feel less lost and unknown when they interact with a complex world of medical specialists.

End Racial and Ethnic Disparities. Evidence shows that disparities remain in the delivery of health services based on race and ethnic origin. This is unacceptable in Massachusetts. I will implement recommendations developed by public health experts to end inequities in care. Under my leadership, Massachusetts will be the first state to close the racial and ethnic gap in heath.

Invest in Prevention. When diagnosed early, many illnesses can be managed at far lower cost than if left until they breed more serious health problems. To keep our citizens healthy, I will invest in a robust public health delivery system. I will place a special emphasis on adequate childhood immunizations, health and nutrition counseling, effective drug and alcohol abuse education, and HIV/AIDS prevention and care. I support the legislative initiative to fund cancer-screening, blood-pressure testing and similar early detection programs. Common sense prevention programs like these reduce system-wide costs, which saves money for insurance ratepayers.

Public Disclosure of Premium Rate Changes and other Health Care Costs. I favor transparency. Because the costs of health insurance have such a profound recurring impact on public fiscal stability and access to adequate care, I believe the public has a right to know how and why their health costs are growing so rapidly. In order to increase transparency and permit employers and citizens to make better-informed choices, I will work to require insurers to disclose and discuss proposed premium increases at a public hearing held ninety days before new increases go into effect.

End the Paperwork Nightmare. The cost of health care's bloated administrative bureaucracy is a hidden tax, continually shifted onto workers and taxpayers even as coverage drops. As governor, I will appoint a high level commission to make recommendations to me within one year of taking office on how to capture the savings from greater efficiencies for all of us, including how existing state-backed programs (like MassHealth) may be transformed into health plans widely attractive to individuals and businesses in the Commonwealth. Leveraging government's buying power and eliminating bloated administrative bureaucracy are the two keys to lower rates and wider coverage.

If you share my vision and support these ideas, or have better ideas, join us by signing up at www.devalpatrick.com. Feel free to
tell me what can be improved or modified to make these programs more effective. Remember, it's your government! Have an impact.