In the Massachusetts healthcare economy, the balance between employer, employee (policyholder, beneficiary), and health plan (insurer) is getting new scrutiny. Its chief executive, Gov. Patrick, filed a bill calling for the broadening of powers of the state’s insurance commissioner in capping rates for care delivery services by hospitals, doctor groups, imaging centers, and insurers. He cites the crippling effect of higher rates on employers and employees of small businesses.

Of course, in a state rocked by lowered reimbursement schedules, a diaspora of primary care physicians to other practice locales with a secondary shortage in those primary care services — the news of capped payments to docs is not generating a lot of support in that camp for Patrick’s plan. And what do the small businesses think? Cautious optimism rules the day. Smaller acute hospitals (who already are at the mercy of government whims with respect to Medicare and Medicaid payments) fear for their bottom lines amid the potential for layoffs and cuts in healthcare delivery services.

Insurance companies have no problem supporting the governor’s proposal, just as long as negotiations of rates with the other parties don’t cut into their bottom lines. | LINK

It was inevitable. Not so much as the ascendancy of former Massachusetts state senator Scott Brown to U.S. Senator status, nor the Republican inheritance of a seat previously deemed as unassailable by any Republican…ever – that of “Liberal Lion” Ted Kennedy. Nope. The totally predetermined response to the reason for the election of a Republican to that vacant seat — that of a referendum on healthcare reform not only in the Mass. Commonwealth, but also by extension, the nation. Right wing pundits and mainstream media outlets wasted no time in adopting the “enough is enough” mantra the movement sees as the singular problematic domestic agenda of the current Obama administration.

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[The following editorial is crossposted at HealthcareWealthcare.com]

I’ve written much on my health policy blog … of the microscope under which the state of Massachusetts is operating its own brand of healthcare delivery in the wake of universal healthcare coverage. The ambitious undertaking by the state’s lawmakers to introduce the concept of universal coverage to its citizens over two years ago attempts to answer the question — can healthcare delivery costs be reined in while mandating care for everyone? The answer is, to the surprise of no one, a resounding “no”. As a matter of fact, the cost of covering an additional 430,000 people has thrown the state’s healthcare economy into a tailspin.

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On the verge of its passage, the reform bill^[1] — which does not house a public option nor a much ballyhooed Medicare buy-in (as if it would), the spinmiesters amongst the Democrats have already started explaining why the party’s acquiescence to the GOP in getting to where we are now is a good thing. Up first, Massachusetts’ only senator at the moment and former pres. candidate John Kerry on why the reform bill is good for his state:

I can announce today not just that Massachusetts will not be penalized for having already reformed its health care system but that the Majority Leader has agreed to include a provision that will provide Massachusetts with additional federal funds for Medicaid for the next three calendar years — roughly $500 million — that’s half a billion dollars — more than we otherwise would have had.

Kerry is essentially promising the state a stimulus package to expand its Medicaid matching funds.  Since Mass. has spent more than double in 2007-08 than what it did in the first year of its Commonwealth Care subsidy, we certainly know that the origins of this $.5B windfall are from nowhere close to Massachusetts — literally and figuratively. Just who is footing the bill for bailing out Kerry’s home turf over its unsustainable healthcare spending? Perhaps he’ll say after he’s re-elected — which is probably the entire point of this photo-op. | LINK

1. The Patient Protection and Affordable Care Act [↩]

At a recent stop in the state to (supposedly) raise money for Gov. Deval Patrick, President Obama deftly avoided discussion of the fierce healthcare reform debate. One can assume, however, that discussions of the Massachusetts pilot program in healthcare access for all occurred privately. And, you can bet that those discussions involved setting a PR agenda to convince skeptical policy wonks that a little pre-emptive damage control is in order if Obama wants to lead by Patrick’s example with respect to reform legislation.

“We did access before costs,” [Gov. Deval] Patrick, 53, said. A federal plan “will have to do it at the same time.”

[Gov.] Patrick said he has been in close contact with the White House and the U.S. Department of Health and Human Services during the health-care overhaul push, advising them on how to “engage the private market and get them to play fair,” the governor said.

Massachusetts rode the universal coverage wave and is currently overseeing an explosion in health costs and spending to maintain it. Clearly, that agenda is not in Obama’s (or the nation’s) best interest. For all of the touting of the state’s (mis)fortunes in its first-in-the-nation status as a bellwhether for reform, there is also enough reality to go around as well. Tax subsidies, tax penalties, and Medicaid expansions don’t come cheaply.  Any connection to a national agenda on reform to the Massachusetts model will have to be made responsibly and lucidly.

Everyone has an opinion on the ultimate mark health reform will make on the economy, the delivery of healthcare, and its impact on patients. Most of those musings can be easily taken with the largest of grains, except those from whom opinions really do matter: healthcare thought leaders and policymakers in Massachusetts — the government-sponsored healthcare proving ground. For all of the song and dance on impact on care quality, disruptive innovation, rationed care, and an altered competitive healthcare marketplace; one aspect on these arguments always comes shining through: nervousness over cost and who will have to suffer the least to come out as if reform never occurred. One thing’s for sure. It probably won’t be the patient. | LINK