jonathan gruber


Mass. Study: Limited Health Insurance Networks Save Money, Cause No Harm

Jonathan Gruber of MIT (Courtesy MIT)

Jonathan Gruber of MIT (Courtesy MIT)

Most patients, myself included, do not like to be told, “You can’t see that doctor or go to that hospital.” But the message is becoming more common as we, patients, or our employers choose what are known as “limited” or “narrow” network plans (note the not-so-subtle name change).

These plans are often cheaper than other options because they cut out expensive hospitals and because insurers negotiate better prices with hospitals and doctors who are promised our business.

But there’s a backlash that’s both real and hyped. Some of the hype is refuted by a study out today.

It looks at a broad movement toward limited network plans in Massachusetts in 2011, when state employees got a three-month “premium holiday” if they switched from more traditional coverage to the lower-cost option.

State employees who chose to switch reduced their health care spending by 36 percent.

“Clearly, this was a big cost-saver for the state,” says study co-author Jon Gruber.

The savings, says Gruber, occurred because patients with limited network coverage relied more on primary care and less on specialists. There is no sign that patients received lower quality care or that their health deteriorated.

Gruber, who had a hand in creating both the Massachusetts coverage law and the Affordable Care Act, claims the political implications of this Massachusetts limited network experiment are profound.

“There’s a lot of discussion about ObamaCare leading to more ‘limited’ choices,” says Gruber, and “isn’t that a shame.” But Gruber says people in these plans “don’t appear to be suffering.” Continue reading

From Consumer Anger To The Supreme Court, 2012 In Health Care

From Jonathan Gruber's new book, "Health Care Reform: What It Is, Why It's Necessary, How It Works

What will 2012 bring in health care? Some of these predictions are decidedly tongue-in-cheek. Others could certainly be labeled wishful thinking. All are interesting to contemplate — and when they’re taken together, a picture of public expectations begins to emerge, from the Supreme Court ruling on health reform to cost trends.

Readers, it’s not too late: This post will evolve until 2012 actually arrives. Please post your predictions in the Comments section or click on “Get in Touch.” You can also vote on which prediction you like best. Most popular predictor will get a WBUR prize still TBD. And by the way, oh, yes, you’ll be held accountable. If fate is good, we’ll still be here one year from now and will award a booby prize to the predictor who was farthest off.

MIT economist Jonathan Gruber (The illustration above is from his new book):
•  The U.S. Supreme Court will find the individual mandate [the heart of President Obama’s health law] constitutional.
Public support for health care reform will grow by the end of 2012.
Innovations such as ACOs [accountable care organizations] and PCMH [patient centered medical homes] will grow rapidly, but there still won’t be convincing evidence that they save money in general – we need more time to build the evidence base.
There will be continued demand for, and growth of, tiered network insurance products and high deductible plans.
This growth will put pressure on the highest cost providers to bring their costs into line.

‘The voice of consumers angry about rising cost sharing and limited choices will continue to grow.’ – John McDonough


Josh Archambault, director of health care policy at the Pioneer Institute:
• Continued provider consolidation, both locally and nationally.
Greater cost-shifting from Medicare and Medicaid, as both federal and state government continue to cut reimbursement levels. On a related side note, I think over the next few years you will see cash-based pre-paid practices opening in Boston.
Gains in the use of high-deductible and health savings account plans nationally. The question for 2012 is whether Massachusetts will break out of its status quo and catch up. Continue reading

A Sneak Peek At ‘Health Reform: The Comic Book’

MIT economist Jonathan Gruber calls health care reform the “biggest social policy legislation since Medicare.” So what better way to explain such a serious, complex and far-reaching topic than through comics?

Gruber, an advisor to President Obama on national reform and a key architect of Massachusetts reform, says he was hesitant to distill such a weighty subject into comic book form but in fact, by explaining the problem graphically, through characters like Betty on Medicare or unlucky Carlos who has to buy his own health insurance, Gruber covers a lot of ground, and is able to lay out the various issues and make his case for the national health law on both a macro level and through gritty details. (“There are no death panels,” the comic-book Gruber, black-and-white and bespectacled, tells a ranting grandmother-type shaking her cane.)

One measure of the book’s clarity and accessibility is that my 8-year-old daughter picked up my review copy and started reading. Health Care Reform: What It Is, Why It’s Necessary, How It Works, will be published by Hill and Wang in January. I spoke briefly with Gruber this week and agreed to post only one image, for now. There’s more to come, though, so stay tuned.

Mitt Romney is the single person most responsible for health care reform in this country.

What’s the appeal of a comic book on health reform?

I think what really convinced me, when you want to educate people, the comic is a great way to do it. When an airline wants you to know what to do in case of an accident, they give you a comic.

Here we have perhaps one of the most complicated topics that people deal with in society, so the idea of explaining it in a comic form is appealing. Really, it’s not a comic book, it’s a graphic novel, it’s trying to use pictures to make compelling what is essentially dry — let’s face it, this is not exciting, it’s not funny, it’s fundamentally a policy argument. Using pictures allows you to use fewer words. Continue reading

Herald Scoop: MIT Economist Gruber Pens Health Reform Comic Book

Christine McConville of The Boston Herald published this delectable scoop yesterday: MIT’s Jonathan Gruber, a leading health economist and adviser to the Obama administration, is writing a long comic book to explain federal health reform to the public.

“I’m going to use the facts to tell the story,” Gruber, 45, told the Pulse yesterday. “I’m the narrator guiding the reader through the law. It’ll have lots of pictures and text.”

Hill and Wang, a division of publishing powerhouse Farrar, Straus and Giroux, plans to release Gruber’s book, tentatively titled “Health Care Reform: What It Is, Why It’s Necessary, How it Works” this fall.

Today, Christine reports that her story “lit up the blogosphere,” including a New York Times blog reader who asked, “This is a joke, right?” Surprise, surprise, many of the multitudinous responses on the Herald’s own Website were hostile to the project, federal health reform and the government in general. Read one: “Can’t wait to see the comic book pictures that show the funny new 15,000 IRS agents collecting money from people already hurting.”

Time magazine’s Swampland blog asks, “Brilliant or bizarre? Maybe both?” The “Economix” blog at The New York Times says mildly, “The comic book seems like a good idea, so long as it’s well executed.”

I’d go a step farther and say, partisan politics aside, it’s a great idea. The more clear, reader-friendly explanations of health care reform and health care economics in general — like the 9-minute Kaiser Family Foundation video above, narrated by NPR’s Cokie Roberts — the better.

Readers, any suggestions for Professor Gruber as he writes??

Daily Rounds: Costliest Patients; Caritas Grilling; Aspirin and Colon Cancer; Drug Rep Flattery; MIT’s Gruber Vs. Tennessee Gov. On Reform

America’s Costliest Hospital Patients – “Some of the sickest patients can run up hospital charges as high as $18,000 a day, with average stays of almost three weeks, according to a new government report on the cost of hospital care.” (The New York Times)

Judge grills Caritas on sale – “Caritas Christi Health Care’s underfunded pension liabilities were the focus of yesterday’s Supreme Judicial Court hearing on the proposed $895 million sale of the Catholic hospital chain to Cerberus Capital Management.” (Boston Herald)

Low-dose aspirin may cut colon cancer cases, study says – The Boston Globe “A low dose of aspirin may reduce colon cancer cases by a quarter and deaths by a third, a new study found.” (Boston Globe)

Dollars For Docs: Drug Co. Flattery Wins Docs, Influences Prescriptions : NPR “Drug companies train representatives to approach a narrow set of doctors in a very specific way, using language that deliberately fosters this idea that the doctors who speak are educators, and not just educators, but the smartest of the smart.” (

Tennessee Governor Phil Bredesen Attacks Health Care Reform … And Gets It Wrong | The New Republic “The gist of Bredesen’s argument is pretty simple: Some firms will find it more attractive to stop offering insurance and let employees get coverage through the new insurance exchanges, where generous subsidies will be available. But the Affordable Care Act, which I’ve long supported, imposes strong penalties on firms that do not offer insurance, as well as sizeable tax credits for smaller firms that encourage them to offer.” (