health reform


What Makes Berwick Run: Spurned Medicare Chief Seeks To Lead Massachusetts

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Don Berwick — pediatrician, health care improvement guru, Anglophile, Obamacare booster — has a really, really great bedside manner. He leans in; he listens. He’s deeply thoughtful about seemingly intractable problems (Medicaid expansion, for instance, or the way doctors get paid) without being alarming. In short, he’s the guy you want in the exam room when your kid falls off the jungle gym.

And if you live in Massachusetts, he wants to be your governor.

The last time you probably heard about Berwick, a Democrat, he was being lambasted by certain (Republican) members of the U.S. Senate who vowed to block his confirmation as President Barack Obama’s designated Administrator of the Centers for Medicare and Medicaid Services. Berwick served as the head of CMS for 17 months, and then, with regret but little discernible bitterness, he returned home to Newton, Mass., and decided to run for governor. (Before heading CMS Berwick served as the director of the Institute for Healthcare Improvement, a nonprofit in Cambridge.)

We spoke with Berwick mostly about health care on his way to more far-ranging interview on Radio Boston. In a 30-minute discussion, Berwick talked about the “majestic” Affordable Care Act and compared re-inventing health care to throwing a hat over a very tall wall and climbing over to retrieve it. Here, edited, is some of our (very long) interview:

So, overall, how is your campaign going?

I’m thrilled by how things are going. Of course, people are interested in health care, it’s a very big issue for our country and our state. We have to get this right. I keep saying the truth, which is that the eyes of the country are on Massachusetts. We’re, what, five years ahead of the country in broadening coverage. Health care is a human right in the state now, and you can’t say that in any other state, and that’s what began in 2006. So we’re kind of pioneers for the country. Now, in order to make that possible, we have to reform health care.

Health care has to meet people’s needs better, at lower cost, without harming anyone, but by making health care better, that’s the best way to improve, to contain costs. That’s the journey we’re on, since the cost containment enterprise is now started, and everyone’s watching, everyone’s watching. Continue reading

Crazy Health Premium Ride Ahead For Mass. Small Businesses



Small business owners and residents who buy health insurance on your own: my sympathies.

The next time you renew health insurance may be an even crazier experience than usual. The Affordable Care Act is changing the factors insurers consider when setting your rates. And, some insurers will benefit more than others, based on a pretty complicated “risk adjustment” for their members. The result is a 30 percent spread between increases and decreases, as of Jan. 1, 2014. It’s the biggest difference in rates that anyone I spoke to has seen in Massachusetts.

Here are the rates for the beginning of the year, and for the next quarter, which the state put out:

Rates in August 2013 with the Massachusetts Office of Consumer Affairs and Business Regulation

Continue reading

Commentary: A Not-So-Rosy View Of Mass. Health Reform

By Josh Archambault
Guest Contributor

Hundreds of healthcare journalists will be attending the Association of Health Care Journalists’ (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict “extreme premium increases” for many small businesses under Obamacare.

In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision.

Josh Archambault of the Pioneer Institute (Courtesy of JA)

Josh Archambault of the Pioneer Institute (Courtesy of JA)

The small business community has been paying more for health insurance since the commonwealth’s 2006 reform merged sicker individuals into the same risk pool. The legislature has also added to costs by passing 12 additional mandated benefits since then, a cost borne completely by small companies and individuals.

Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years. That translates into employers and consumers in Massachusetts paying $213 million in 2014 and $3 billion more over the next decade.

Conference speakers will be sure to mention that the Connector was created to help small companies obtain competitively priced insurance, and other states will experience this benefit in the exchanges required under the federal law. Only one problem, the rhetoric doesn’t match reality in Massachusetts. Continue reading

Gruber Responds To Economix Critique Of Health Reform

Massachusetts health reform in general and its advocates in particular were the target of a pretty harsh critique yesterday in The New York Times’ blog, Economix.

The post, by University of Chicago Economics Professor Casey Mulligan, argued, among other things, that the U.S labor market is “in for a shock” when health reform takes full effect despite how “smoothly” things may have appeared when Massachusetts carried out its own health reforms starting in 2006. Mulligan writes:

Beginning next year, millions of Americans will be eligible for generous subsidies in the form of cash assistance to pay for their health insurance premiums and out-of-pocket health expenses pursuant to the Affordable Care Act. The subsidies will sharply reduce the financial reward to working because they will be phased out with household income.

Jonathan Gruber of MIT

Jonathan Gruber of MIT

Mulligan then goes on to trash MIT economics professor Jon Gruber, a key adviser on both state and national health reform, for his defense of the Bay State’s reform efforts:

When it comes to quantifying the new federal law’s penalty on employment, Professor Gruber and Health and Human Services are incorrect to take comfort in the Massachusetts experience since 2006. As I explained last week, the federal law’s employer penalty is more than tenfold the Massachusetts penalty. In other words, if the Massachusetts penalties pushed down workers’ wages by 16 cents an hour, the federal penalties would push them down $1.67.

Professor Gruber is also incorrect that the federal law is introducing less generous subsidies than the Massachusetts law did. Federal subsidies will be available for people laid off from their jobs, but the new Commonwealth Care subsidies in Massachusetts are not, because Commonwealth Care excludes people eligible for the Medical Security Program (a longstanding program providing health benefits to Massachusetts people receiving cash unemployment benefits).

I asked Gruber to respond to Mulligan’s critique. Here, unedited, is what he sent over via email:

Problems with Mulligan argument:

1) He cites as supporting evidence a 1994 article that referred to a completely different policy

2) He ignores the fact that the disincentives to income increase in MA are massively larger than in the federal program. Continue reading

Can My Company’s Wellness Program Really Ask Me To Do That?

doctor exam

(Wikimedia Commons)

“Wellness” is like apple pie, isn’t it? What could possibly be bad about companies helping their workers be healthier?

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Why should you foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers?

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy? Continue reading

Health Reformer’s Red Past Revealed!

Harvard professor and author John E. McDonough

Help! I seem to have entered a time warp to the McCarthy era! Or maybe a wormhole back into the Cold War!

Some sort of Red Scare nightmare? No, I’m just in a state of bafflement after reading “The Socialist Behind Romneycare.” Posted by the right-wing group Accuracy in Academia, it targets Harvard School of Public Health professor John McDonough, who was involved in building both Massachusetts and national health reform and is the author of “Inside National Health Reform.” (Also, these days, the Health Stew blogger for the Boston Globe.) The post reveals that (gasp!) more than thirty years ago, McDonough belonged to the Democratic Socialists of America and chaired its Boston chapter for a couple of years.

The post cites work by blogger and Communist-outer Trevor Loudon: “Loudon’s new report, which is potentially embarrassing to Mitt Romney as he tries to prove his conservative credentials, is headlined, “How DSA Marxists Influenced Health Policies for Both Major Presidential Candidates.”

Now, I know that living in Massachusetts distorts my vision and leaves me insensitive to the realities of national politics, and I know that I should never try to find true logic in political game-playing. But I can’t help asking: Could anybody, anywhere, really care anymore if a politician or a professor — or a health care reformer — once propounded socialism? The Cold War is over, Communism couldn’t be deader, “Are you now, or have you ever been, a member of the Communist party?” has become synonymous with McCarthy-era abuses. And if Mitt Romney praises the Israeli health system, is it some sign of pernicious socialist leanings that in his latest blog post, McDonough praises the French?

Breaking: Mass. Aims To Set First-In-Nation Health Care Spending Target

Massachusetts leads the nation once again, this time with Phase II of health reform.

A 350-page bill filed five minutes before a legislative deadline for the year sets the first statewide target for health care spending in the U.S. Massachusetts would aim to hold health care cost increases to same rate as the state’s economy through 2017.

Specifically, health care costs could not rise faster than the Gross State Product from 2013 to 2017. The target would go lower (GSP minus .5) from 2018 to 2022. From 2023 on, it would return to even with GSP, but would be open to revision by the new oversight agency created in the bill. (The bill refers to the “potential” growth rate of the state’s GSP). The bill summary is here and the AP coverage here.

One estimate of savings, prepared by Diana Eastman, Research Assistant, Harvard School of Public Health

That agency will be under the governor’s secretary of Administration and Finance. Legislators say it will look like the current Division of Health Care Finance and Policy (DHCFP), but with two separate missions: collecting unbiased data and establishing health care policy (setting ACO requirements, deciding whether the state has hit the GSP goal, tracking the move to global payments, for instance). The cost of getting this expanded agency up and running is expected to be $31 million, that’s $11 million more than the state spends on DHCFP now. The Legislature plans to file a funding bill for the agency next year. Continue reading

Mass. Taxpayers Foundation: Health Reform Gets Bang For The Buck


When the cost-conscious Massachusetts Taxpayers Foundation tells you something is a good deal — or as my Boston-accented dad likes to say, a bah-gain — you can be pretty sure you’re getting your money’s worth.

WBUR’s Martha Bebinger reports that the group has just put out a new report on Massachusetts health reform that could act as an important corrective for claims on the national political scene that the reform has been a budget-buster. Read her full report here. It begins:

Outside Massachusetts, talk show hosts and politicians frequently blast the state’s health coverage law as a “budget buster.”

“It has been an abject failure,” Senator Rick Santorum told the audience during a presidential primary debate in January, directing his comments towards former Mass. Gov. Mitt Rommey. “He’s stood by the fact that it’s $8 billion more expensive than the current law.”

That’s just one of the myths the Massachusetts Taxpayers Foundation (MTF) hopes to debunk with a report out Friday. The facts will help. Michael Widmer, president of the MTF, says the state has spent just $91 million more a year since 2006 to cover the uninsured than it was spending before the law passed.

“That’s a very tiny additional costs to taxpayers for huge benefits,” argues Widmer. “No way can one say that this has been anything close to a budget buster. The facts put a lie to this myth.”


Will Global Payments Make Sue A Cheaper Patient? Please Discuss

Sue Beder

Patient Sue Beder, left, and Senior Whole Health nurse Judy Tremblay (Martha Bebinger/WBUR)

WBUR’s Martha Bebinger has me in suspense. She has just launched her “Most Expensive Patient” series, following Sue Beder of Stoughton, a 65-year-old woman with multiple sclerosis. Sue is one of those super-costly patients who make up just 5% of the population but account for half of the country’s $2.6 trillion annual medical bill.

Now, she has just signed up with an agency that’s aiming to improve her health while cutting costs, by putting her care on an overarching budget instead of paying piecemeal for each service. That’s exactly the sort of plan involved in the second stage of health reform now brewing in Massachusetts. Martha writes: “As more and more patients are covered by global payments, Beder represents the future of health care in Massachusetts. And, if health care on a budget doesn’t work for high-cost patients such as Sue Beder, it may not make sense for any of us.”

Be sure to read the whole story here, and please let us know what you think in the comments section below. My initial reaction: The budgetary side remains to be seen, but for goodness sakes, anything that keeps a patient from needing to call the fire department 40 times a year for help has got to make sense.

Compare spending for Sue Beder: Fee for service vs. Global payment

CLICK TO ENLARGE and compare spending for Sue Beder. (Aayesha Siddiqui for WBUR)

10 Signs That Mass. Mostly Likes Health Reform, Really And Truly



You know how it is: When your town or your company or, heaven forbid, your family or friends are portrayed in the media, its funhouse mirror tends to distort them almost beyond recognition. That’s a bit how it felt during the Supreme Court health law hearings this week as national media outlets turned their spotlight onto Massachusetts and came up with headlines like this one in The New York Times: “In Massachusetts, Insurance Mandate Stirs Some Dissent.”

I mean, not that there’s no dissent here. Of course there is. A WBUR poll earlier this year found that 33% of residents oppose the state’s health reform law. But I think many of us would agree that the newsworthy, surprising, man-bites-dog moment here is how little dissent there’s been. (Kudos to the Worcester Telegram & Gazette for choosing this headline for that same Times story: “A few Mass. residents still without health insurance.”)

We asked WBUR’s Martha Bebinger, who has covered Massachusetts health reform with unmatched energy and expertise since before it passed in 2006, for a reality check. “I’ve been looking for a movement of dissenters for six years and haven’t found it,” she said. “I have a handful of people I call regularly and ask, ‘Are you doing anything?'”

The Facebook page for ‘Massachusetts Against The Individual Mandate’ got only43 ‘Likes.’

Here are 10 points that back up our impression that health reform has turned out to be strikingly palatable to most here in Massachusetts:

• A WBUR poll released in February of this year found that  62 percent of residents support the Massachusetts health reform law while 33 percent oppose it. (In the WBUR report on the poll, pollster Robert Blendon notes that people outside the state have a hard time believing how accepted the reform is here.)

• A 2011 poll by The Boston Globe and the Harvard School of Public Health similarly showed that 63 percent of Massachusetts residents supported the state law, and that support had risen since 2009. The federal law has an approval rate of 41 percent, and an unfavorable view by 41 percent of those surveyed, according to a monthly tracking poll by Kaiser.

• In Massachusetts, there have been no major court challenges or attempts to overturn the health insurance requirement.

• Backers of an initiative to repeal the individual mandate in Mass. failed this fall to get enough signatures to appear on the ballot. Continue reading