, Salem, MA


May 3, 2014

Column: We have met the health care enemy

If you’re not feeling dazed and confused by the health care system, you’re not paying attention. State reform, federal reform, broken websites and promises, seismic changes in the health care industry — all these developments are creating uncertainty for consumers, businesses, doctors, hospitals and health plans.

Without a doubt, the old system was broken. The traditional fee-for-service model — in which providers were paid per test or procedure instead of by patient outcome — drove up volume and cost. At the national level, my own industry, health insurers, erred badly in not fixing its own house by guaranteeing coverage and covering people with pre-existing conditions, as Massachusetts health plans have done for years.

The government fixes have gone a bit too far in some areas, however, fixing some things that weren’t broken and breaking some things that were already fixed. One example is a provision in the Affordable Care Act that deals with how risk is spread among individuals and small businesses purchasing insurance. The result is that rates for some of those individuals and businesses are going up as much as 100 percent. That’s just not fair.

What else can we expect? Our experience in Massachusetts, which was the basis for the federal Affordable Care Act, offers a glimpse into the future. When you cover everyone, cost quickly becomes the issue. Squeezing costs puts pressure on providers, which leads to consolidations, which lead to … higher prices. It also creates an adversarial relationship between providers and insurers, impeding the kind of cooperation that will be necessary to control costs in the long run. Public health care programs — namely Medicare and Medicaid — are going to expand without additional funding and, as a result, those paying for private insurance will subsidize a bigger and bigger portion of the cost of those programs.

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