An Evolution In Health Care

I think it's clear that this health care reform bill will not be the last one ever passed by the US Congress. Once certain mechanisms get set in place, they become hard to dislodge, and further actions will refine them and improve them. That's the feeling behind the progressive push for the public option. If that gains a toehold, in the future we can expand access or change the delivery system. I fear that a carefully circumscribed public option may never get off the ground, but I think that's the theory.

And that theory got more credence with an action by Massachusetts on Friday. They implemented their universal health care plan, not totally different than the Democratic plan in Congress, which expanded access but didn't have any cost controls. So the costs have continued to rise, forcing a choice from the state - scale back the program, or apply enough cost savings to keep it going. They opted for the latter, in an interesting way:

A high-level state commission recommended Thursday that Massachusetts seek to rein in health care costs by radically restructuring the way doctors and hospitals are paid.

The commission’s action kicks off the second phase of a health care overhaul that has succeeded in covering nearly every resident of the state but done little to slow the relentless growth of spending.

The recommendations, if approved by the legislature and Gov. Deval Patrick, would make Massachusetts the first state to end the practice of paying health care providers for each office visit, laboratory test or procedure.

Instead, primary care physicians, specialists and hospitals would group themselves into networks that would be responsible for a patient’s well-being and would be compensated with a flat monthly or annual fee known as a global payment.

That would be remarkable, to end fee-for-service medicine in the US. And because Massachusetts has expanded access, there may be enough patients to keep doctors in the state, instead of them all fleeing to where they can get paid per treatment. If this works in Massachusetts, then I would really be excited about getting any reform done and managing some of the details later. We need to look at this as the means to an eventual end of the US joining the community of industrialized nations providing decent care for their citizens at an affordable price.