Money talks, common sense walks in Mass., insurance debate
By Dr. John Abramson
Sunday, January 1, 2006

M ost of the people working toward universal health insurance believe health care is a basic right of all Massachusetts residents. At first blush, though, it looks like Bay State businesses are trying to foil this effort by balking at the 5 percent to 7 percent payroll tax on employers with more than 10 workers that don't offer health insurance.

But businesses - as well as taxpayers - certainly have good reason to resist the double standard being foisted upon them. They are being asked to purchase a product - American health care - that is more than twice as expensive as it is in other industrialized countries, yet produces the worst results (measured in years of healthy life) and meets quality standards only 55 percent of the time. Business people know if they ran their own companies this way, they would quickly be out of business.

If you want to understand what's really going on, you have to answer the following question: In the state with the highest health-care costs in the country, what do the two largest and most powerful nonprofit health-care organizations have in common?

Both Blue Cross and Blue Shield of Massachusetts and Partners Health Care's two flagship hospitals combined (Massachusetts General and Brigham and Women's) earned about a quarter of a billion dollars in surplus (read profits) last year. They also dominate the political debate and share a lobbyist to represent their common interests.

Talk about the tail wagging the dog. These health-care behemoths don't want to miss any opportunity to lock in their profits. They want to see more Medicaid money dispersed to all hospitals, whether or not they are already rolling in cash - and whether or not some hospitals really need it to continue providing care to the poor. They want to see more money extracted from lower-income workers and more money from businesses already struggling in a difficult economy.

What is not being talked about is much more telling. Independently, researchers from Dartmouth Medical School and data from the Organization of Economic Cooperation and Development have arrived at the same conclusion: About one-third of American health care is unnecessary and often harmful. In other words, in Massachusetts we are now wasting about $15 billion each year on unnecessary care, far more than is needed to provide universal access for all Bay State residents.

Dr. Barbara Starfield, a professor at Johns Hopkins University, calls it the Inverse Care Law: People with health insurance get too much medical care and people without it get too little.

Why aren't we talking about these core issues? The real divide in this debate is not between those who believe in universal health care and those who don't. It is between those who are making a lot of money in our extravagant and inefficient health-care system and those who are footing the bills.

Wealthy providers (such as Partners) and insurers (such as Blue Cross), along with the medical industries and drug-money-dependent universities, would prefer not to discuss the waste, inefficiency and low quality in American health care right now.

The conference committee trying to reconcile the House and Senate health-care bills cannot arrive at a solution without addressing these core problems.

Massachusetts has a chance to become a national leader in providing effective health care to all its citizens. The first step is developing the political will to stand up to the medical industries - both nonprofit and for profit - that are dominating the debate