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Romney Care 2.0
Editorial, The Wall Street Journal
(Aug 06, 2012)
With costs rising fast,
Massachusetts moves to dictate medical care.
New York, NY
-- ObamaCare's illusions are starting to fall like
autumn leaves, even among some liberals, and what they're discovering are
things that have happened over and over again in Massachusetts. Beacon Hill
"reformed" health care four years before Capitol Hill, and ever since it has
reliably predicted the national trend—on surging costs, price controls,
physician shortages and so much else.
So Boston's latest adventure
deserves particular scrutiny, since odds are its methods are coming soon to
a hospital near you. After more than a year and a half of debate, last week
the legislature passed a far-reaching "cost containment" bill that
Democratic Governor Deval Patrick is about to sign. It is the inevitable
postscript to the model that Mitt Romney introduced in 2006.
The claim then, as with the
Affordable Care Act, was that health care would be less expensive if
everyone had insurance. Soon Massachusetts Democrats leaked that their
political strategy all along was to expand coverage only, because had
RomneyCare seriously squeezed providers it never would have overcome
industry opposition. "Bending the curve" on costs could be saved for another
day, once a vast new government liability was locked in.
Sure enough, 79% of the
newly insured are on public programs. Health costs—Medicaid, RomneyCare's
subsidies, public-employee compensation—will consume some 54% of the state
budget in 2012, up from about 24% in 2001. Over the same period state health
spending in real terms has jumped by 59%, while education has fallen 15%,
police and firemen by 11% and roads and bridges by 23%.
spends more per capita on health care than any other state and therefore
more than anywhere else in the industrialized world. Costs are 27% higher
than the U.S. average, 15% higher when adjusted for the state's higher wages
and its concentration of academic medical centers and specialists.
The health-care postman
always rings twice, and now medicine itself is the target, instead of
unsympathetic insurance companies. Under the plan, all Massachusetts
doctors, hospitals and other providers must register with a new state
bureaucracy as a condition of licensure—that is, permission to practice.
They'll be required to track and report their financial performance, price
and cost trends, state-sanctioned quality measures, market share and other
The best that can be said is
that in principle such transparency could increase useful information about
cost and quality. Today's lack of comparative tools makes it hard for
consumers to search for value in health care, even when they have the
incentive to do so.
But Massachusetts takes
360-degree surveillance and converts it into a panopticon prison. An
11-member board known as the Health Policy Commission will use the data to
set and enforce rules to ensure that total Massachusetts health spending,
public and private, grows no more than projected gross state
product through 2017, and 0.5 percentage points lower thereafter. (And Paul
Ryan's Medicare projections are unrealistic?)
No registered provider is
allowed to make "any material change to its operations or governance
structure," the bill says, without the commission's approval. The commission
can also rewrite the terms of provider contracts with insurers and payment
levels and methods if they are "deemed to be excessive."
As the commission polices
the market, it can decide to supervise the behavior of any provider that
exceeds some to-be-specified individual benchmark—that is, doctors and
hospitals that are spending too much on patient care. These delinquents must
submit a "performance improvement plan" that the commission must endorse.
In other words, the
commission is empowered to control the practice and organization of
medicine. The Massachusetts left complains that this government control is
too weak because the delinquents can only be fined $500,000 for disobeying
the commission's dictates. But more teeth can always come in round three
when this plan fails, as it will.
The main reason is that the
enlightened planners never allow for the complexity of medicine in the real
world. For example, Medicare has for years been trying to lower hospital
readmissions using the strategies across the health policy universe—generate
performance and quality measures, then pay "good" hospitals more and the
But it turns out that many
of the supposedly bad hospitals also have much lower mortality rates than
the ones Medicare is rewarding in its readmission programs monitoring heart
attack, heart failure and pneumonia. The reason is that patients who die
can never be discharged and then readmitted if something later goes wrong.
The alleged underachievers that Medicare punishes are often much better at
treating sick people and saving lives, less good at crunching the numbers.
Despite these Medicare
failures, Washington has never gone as far as Boston is now going,
installing itself as the arbiter of care in order to redesign care, though
under ObamaCare it's only a matter of time. Everyone agrees that the health
system needs to deliver medicine more efficiently and be more accountable,
but accountable to whom? The answer for the political rulers of medicine, if
not patients, is always: government.
– FM Duck
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