Health-care rationing coming to Massachusetts

Posted by: steveegg on October 12, 2009 at 1:57 pm

(H/T – Instapundit via Ed Morrissey)

The Boston Globe reports on efforts to cut the costs of RomneyCare:

The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers….

A state commission recommended in July that insurers largely scrap the current fee-for-service system – in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit – and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.

Where do I begin with this one? It is absolutely no wonder to one who knows human nature that, when there is no perceived difference in personal cost between one option and the next, one will seek out the most-expensive options in the belief that it is the best.

The whole reason HMOs, which are defined provider networks, have been reviled is that they do limit access to where one gets health-care treatment. As the article notes, with the average resident of Massachusetts having freedom of movement, reinstituting an HMO-style limitation on where one can get health care is going to go over like a lead balloon.

Yet even that limit isn’t the only item being talked about. The proposed “solution” to the problem of too much money going out the door for health care, a hard cap on how much will be paid for all health care for a particular patient, is even worse. What happens when the cost of the next medically-necessary procedure, even if it’s done in a third-rate care clinic, busts that cap (after all, several things can happen in a compressed timeframe)? The Professor’s close is a good one – “Think of them as ‘life’ panels, because they’ll decide if you get to live!

A third idea is limiting the amount of money the “expensive” teaching hospitals get for procedures. I’ll let Ed handle the bulk of that argument:

The result of that approach will be very easy to predict. The best hospitals will take primarily those patients who can afford to pay their premium prices, leaving the poor and middle-class patients to get treated elsewhere. It will stratify health care much more than before Massachusetts enacted its “reforms”, giving the rich almost exclusive access to the best care. And thanks to lousy compensation rates, fewer new providers will be around to meet the new demand in second-tier care, meaning much longer wait times for the poor and middle-class patients.

There is another bad side effect of limiting payments to teaching hospitals; they will either have to charge even more for tuition to the student-doctors, or they will have to accept fewer student-doctors. In either case, that will reduce the future availability of health care.

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12 Responses to “Health-care rationing coming to Massachusetts”


  1. dr kill says:

    Few Americans understand stratified health care is now here. Already creative American MDs are banding into surgery facilities where they control the patient load. Already hospitals are failing as the well-insured follow their practitioner to his facility.
    The greater misunderstanding concerns the percentages of high quality care vs lower quality care. Today all but the uninsured are provided great care, but after several years of Romneycare nationwide only the wealthy will have the standard of care almost all of us have today. I see the change in terms of 85 to 15 percent decrease in availability.
    There will be a loss of interest in Med School in intelligent American students as earning potential drops. But the solution I see coming is not so stupid as ‘restoring prestige’ idea I saw discussed at Megan McCardle’s blog last week, but offshore MDs. There are lots of third world-educated docs who would love to practice here. Just check the doctor roster of any State or Federal department and see what I mean. They are all from offshore, and not able to be in private practice because they can’t pass the tests, but that little problem doesn’t stop government from hiring them at a salary Americans laugh at.

    Coming soon to a hospital near you, soon as government makes a few affirmative-action changes to licensing requirements.

  2. Carlos says:

    But you guys aren’t looking at the unicorn/pixie dust factor. Like the old saying goes, if you can imagine it, it can happen.

    When it comes to socialist health care (or nearly any socialist program), my answer is, no, it can’t.

  3. Steve: Posted and linked your piece at my blog.

  4. Ron Russell says:

    Great post, yea I would prefer the Rolls to the Beetle. Don’t worry that choice want last long.

  5. MarkJ says:

    Typical Democrat approach to a program that’s clearly failing in one state: impose it on the whole country.

    “I feel a-hunka, hunka burnin’ failure in this room.” (Elvis, 1977)

  6. Kate says:

    So here is the handwriting on the wall, so to speak. The ideology does not translate into a practical application. We have a test group in Massachusetts and control groups in other states. The results are starting to come in and they are negative. If this was a clinical medical trial, it would be stopped immediately due to progression of disease and/or ineffectiveness of the drug/procedure being tested. Time to go back to the drawing board. How many think that will happen in Massachusetts???


  7. Carlos says:

    Since liberals (and is there anything but in MA?) look only at the intent of legislation, not results, I wouldn’t count on MA changing anytime soon. Liberals truly believe that if one sprinkles enough pixie dust (known to the rest of us as what used to be our money before the government stole it) often enough all problems can be solved. Even runaway conservatism, if they can just build enough “re-education” camps.

  8. Wallace says:

    A state commission recommended in July that insurers largely scrap the current fee-for-service system – in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit – and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.

    Isn’t this in effect letting the insurers be the money collection agencies and forcing doctors to be the insurers?

    Think about it, doctors are paid annually regardless of how many procedures they do. If they happen to have less patients (many people are healthy), they get more money than what they would have gotten in the free market. Otherwise, they’ll work their ass off, getting less for what they would have gotten for their services. The insurers push their risk to the doctors. Isn’t that by definition making doctors the de facto insurers?

  9. Kate says:

    You are onto something there Wallace…..looks like a new way to scam people into health care. I have seen some chiropractors who use a this sort of subscription coverage for their routine care and maintenance of patients.

    But, that’s predicated on people opening their wallets and participating so they even have a doctor. They are assuming that somehow human nature will change in their system too. There are people who just don’t care to put up the money in advance for anything…

    Can you also imaging the doctors having to manage this financial burden….keeping track of patients they might not see to make sure they keep paying to stay on their “list” of approved patients. I can’t imaging calling my family doctor to be informed: “Mrs. Jackson your patient acceptance fee is due at the time of your appointment. That will be $325 for six months or $650 the year. Please be aware we cannot accommodate you without this.” (that’s just an arbitrary amount on my part)Who do you think will be able to see a doctor under those conditions????

  10. Wallace says:

    Yeah, I don’t think doctors should manage the annual fees. The insurance companies will do that. They collect the money and pay the doctors the annual fees. The insurance companies are then free of risks. It does not matter how many people fall ill, their cut is the same. Let the doctors get overworked. This is a bad idea. Who wants to go to medical schools to be doctors in that kind of situation?

    Now, if a doctor wants to work for a fixed annual salary for a company/hospital/clinic without any pressure, good for him/her. Other people in different professions have no problem working for a fixed salary. However, putting the pressure on them to accept a bad deal is a really bad idea.

    The decline in health care starts with decline in the quality and quantity of doctors.

  11. Kate says:

    Unfortunately, Wallace, THEY believe the health care system is already broken! And you are probably right that the insurance companies will have to administer (more fees) the paperwork and keeps things updated. But still, the primary care physicians will have to inform patients of prevailing rules and to check your status before you even step into their office…for fear of not being paid. That’s a far cry from patient care!

    I predict the government will have to set up a lot of clinics in highly populated areas….I pity the poor doctors who will be prevailed upon to work exceedingly long hours. The fatigue of the doctor is not good for the health of the patient. So will the government HAVE to get involved in TORT REFORM when their clinic doctors start making poor choices due to lack of sleep that in term create bad outcomes. (I would hate to be at one of their Morbidity & Mortality conferences!)