Sunday, August 5, 2012

In Massachusetts,  Ten “Bold” Bureaucracy Measures to Contain Health Costs
“Massachusetts Takes on Health Costs: Is the Plan Bold Enough to Slow the Growth of Rate of Spending.”
August 5, 2012 -  In Massachusetts, U.S,  home of the universal coverage and the individual mandate, the cost controlling trajectory, presumably leading to single-payer, goes like this.
One,  Pass a “universal coverage” bill with an individual mandate, as the state did under Governor Romney in 2006.
Two,   stand back and watch premiums rise to the higher level in the U.S, wait to see physicians grow to the longest in the U..S.,  and the emergency rooms become overcrowded.
Three,  Establish a commission to monitor growth in spending to limit growth in spending at or below state growth in GDP.
Four, Require providers and insurers to explain  why costs rise above target levels or suffer a $500,000 fine.
Five,  encourage doctors to  join “accountable care organizations” with bundled bills and capped budgets, which put them at financial risk and move away from fee-forservice are.
Six, Have Medicaid and state employee programs  adopt alternative to fee-for-service.
Seven, spend $60 million for programs to reduce obesity, dibetes, asthma and other chronic diseases.
Eight, spend $30 million to speed  conversion  to electronic health records
Nine,  work on malpractice reforms without imposing caps on damage awards and malpractice reform without imposing caps on damages.
Ten, think about making physician acceptance of  Medicare and Medicaid patients as a condition for medical licensure.
“Some critics, a New York Times editorial, “will nto have the persaonel and resources to do an effective job of enforacing these provisions – which may be “toothless.”   It goes on, “But don’t  count Massachusetts out. It led the way in expanding coverage.  What happens there on cost control will offer valuable lessons for the rest of the country.”

We won’t count it out.  But we won’t count it in eithr  So far it has failed to manage costs. As the late Peter Drucker observed, “Government is a poor manager. It is, of necessity, concerned  with procedure, for it is also, of necessity, large and cumbersome. It must administer funds and must account for every penny. It has no choice but to become ‘bureaucratic.’  Every government is, by definition, a ‘government  of forms.’ This means high costs.  For ‘control’ of the last 10 percent of phenomena  always more than control of the first 90 percent .”
Tweet:  Massachusetts is taking “bold” bureaucratic steps to cut health costs; if past experience in any guide,, don’t count of positive results.

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