Motley Moose – Archive

Since 2008 – Progress Through Politics

An idea too good to work?

Reading the New York Times this morning, I came across an article on the the crisis facing Massachusetts’ universal health care programs. If you remember, in 2006, then-Governor Mitt Romney and the Democratic-legislature of Massachusetts enacted a state-wide mandate requiring almost every state resident to obtain health insurance. To accomplish this, Massachusetts provides subsidized health care for residents earning up to 100% of the Federal Poverty Level, and partially subsidized health care those earning up to 300% of the poverty level.

Of course, when it came to footing the bill, both Governor Romney and the Democratic-controlled legislature basically shrugged their shoulders and said, “Eh. Let the next bath of politicos worry about it.” This, of course, is ridiculous behavior, no matter your political affiliation. And, of course, that day of reckoning has arrived already, some three short years later.

Last year, Massachusetts lawmakers, led by Governor Deval Patrick, enacted a series of taxes and fees to help keep the system solvent- which has stabilized things for the time being. But optimistic reports suggest that won’t last more than five years or so, depending on the breadth and depth of the current economic crisis. So, in order to finally address this problem, the Legislature has come up with a good idea. I know- these are rare, coming from our politicians. It’s such a brilliant idea, in fact, that it’s almost certain never to be enacted.

But it sure makes you think.

From the Boston Globe, in an oddly roundabout way from The New York Times:

… a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided.

Did you catch that? They want to pay people- insurers, health care facilities, etc- on the basis of quality, not quantity. What is the world coming to? And why did nobody think of this years ago?

Of course, people have thought of this idea in the past. In fact, it specifically was not brought up in the 2006 legislation because it would have likely driven many special interest groups into opposition of the legislation. If health care providers are rewarded for using invasive surgical techniques to solve problems that could be fixed with exercise, diet and hypertension medicine- why would they? They’re going to use the much more profitable option and flay the poor bastard open.

However, those groups are now fully engaged in the current system and have a vested interest in making sure it can stay solvent. So they’re much less likely to resist this plan. Now, this all rests on the Federal government letting Massachusetts change the way it awards it’s share of Medicare and Medicaid funding. But if they can get it done, this could revolutionize the way health care is provided.

Preventative care works, and it’s cost effective- that’s why insurance pays for it. Let’s just hope Massachusetts gets a chance to see if this works or not.


  1. HappyinVT

    to the Massachusetts plan.  If this is the case it would be nice if they would look at this part, too.  He has often said preventive care is extremely important so, whether he uses MA’s plan or not, it appears that prevention will somehow be included.

    I also wonder whether the MA plan or the national plan would include alternative medicine sources.

  2. anna shane

    and several decades ago I was diagnosed with melanoma which was caught very early. I have been avoiding check ups recently, for reasons of too busy and not worried enough, and I got a registered letter from the derm department, telling me to get my butt in there and get a check up.

    That’s what it means.  

    It means contacting patients who are over-due for preventative check ups, it means checking that medications are ordered and in some cases used as prescribed, it means asking about smoking, and about drug/alcohol use and making appropriate referrals.  It’s time consuming only in the computers need programming, the patients need auditing from time to time, and the health care providers need to understand how real people work.

    In the bad past cars had many dangerous features, and it was up to the driver to drive safely despite the operating problems.  There is no wonder that kids get killed more in car accidents, they often driver older cars that have problems.  We can’t rely on personal responsibility when the public picks up the cost, we need to practice smart medicine, which is always preventative when possible, and early treatment when prevention isn’t enough.  

  3. creamer

      The cost savings in this approach would seem to depend on people taking better care of themselves and listening to their doctors. It’s a great idea, but we are Americans after all.

     If people don’t follow instructions do we penalize them in some way?

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