Unbiased Analysis of Today's Healthcare Issues

Is Massachusetts getting a singler payer system?

Written By: Jason Shafrin - May• 20•14

Maybe, if Donald Berwick becomes governor.  Mr. Berwick is the former administrator of the Centers for Medicare and Medicaid Services (CMS). He ran CMS between 2010 and 2011, but left when Senate Republicans blocked his confirmation to lead the agency permanently.  Now, WonkBlog reports that Mr. Berwick is running for governor of Massachusetts.  His platform claims that the state–whose earlier reforms largely inspired the Affordable Care Act–has not gone far enough and needs a single payer system to hold down costs.  Below is an excerpt from an interview Berwick gave with WonkBlog.

In the beginning of your campaign, you said you wanted to look at single-payer as an idea. But it seems you’ve shifted and said, ‘We should definitely go for this.’

I realized as I laid out a platform I wanted to have for health-care reform in the state, its delivery reform — the system has to function at a much higher level of quality and much lower cost. I know what that looks like. I spent 30 years of my life working on better care at lower costs, but that involves reconfiguration around completely integrated care, team-based care, putting mental health services in the middle, making sure that prevention is taken very seriously instead of as an afterthought.

As I worked through that plan, payment reform is essential. The legacy system payment reform [in Massachusetts] right now is Chapter 224, which is a voluntary effort to move toward global payments, away from fee-for-service, toward agreed targets for total cost rise that are more modest than we’ve lived with. I was concerned right at the start about the lack of teeth in Chapter 224. … The more I thought about it and looked at the data and the Vermont plan, the more I realized that having a single-payer system, Medicare-for-all at the state level, could be a big accelerator to the delivery system redesign that we need.

In Massachusetts, it’s the insurance system that’s driving delivery system reform with what Blue Cross Blue Shield has been doing with the alternative quality contract. What’s your sense of how well that’s going?

I credit Blue Cross for what they’ve done. It was a good move. It’s being increasingly embraced in the state, and it’s making some dents to the rate of rise [in costs]. But it’s not enough. We need a more powerful set of tools for making the health-care delivery system where it needs to be. We’re getting back only a fraction of what’s available if we’re going to change the way care is given. It doesn’t address administrative costs fundamentally. It still leaves us with a mixed model, and the amount of change in the delivery system is still very modest. We don’t see migration to the completely integrated system that we really need.

Berwick does identify a key problem with the ACA and with Massachusetts earlier reform. Although both policies improved health insurance coverage, they did little to hold down cost. Clearly, a single payer could hold down costs. The question is, can a single payer do this efficiently without harming patient outcomes? Your political leanings will likely provide you with your own personal answer to this question.

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One Comment

  1. Dennis Byron says:

    A couple of misleading statements about Berwick and a couple about Massachusetts:

    1. “He ran CMS between 2010 and 2011, but left when Senate Republicans blocked his confirmation to lead the agency permanently.” In other words, the Democrats never put his about to be declared illegal recess appointment forward for nomination they loved him and his NHS aspirations so much. And give Berwick credit for the healthcare.gov fiasco that he oversaw during that time (when all the decisions leading up to last year’s roll-out were made).

    2 “I know what (better Massachusetts health care delivery) looks like. (it) involves reconfiguration around completely integrated care, team-based care, putting mental health services in the middle, making sure that prevention is taken very seriously instead of as an afterthought.” Over 50% of Massachusetts residents already participate in such arrangements (except maybe for the mental health blah blah since normal people have no idea what that means). And we have had that care for 40 years. Is he going to make everyone else in the state move to managed care using the Massachusetts National Guard?

    3. “Medicare-for-all at the state level, could be a big accelerator to the delivery system redesign that we need.” Wow. Medicare is notorious as the worse fee for service offender but even 30% of Medicare beneficiaries have already moved to the system he is proposing for the future (over 50% of baby boomers). But fee for service Medicare only covers half a beneficiaries healthcare costs on average. Almost everyone on fee for service Medicare makes other arrangements, mostly through private insurance.

    4. Berwick knows so little about Massachusetts that he does not know that our earlier “reform” (assuming he means the 2006 law and not the 1988, 1991, 1996, 2000, 2008, 2010 — twice — or 2012 “reform” laws) that he does not know that it did not improve our rate of uninsured on a statistical basis. In absolute numbers the percent ticked up a couple of points because of Medicaid, not insurance. What an accomplishment: the state gave a plastic card that few doctors will accept to a few percent of the population.

    5. Why is it clear that single payer will hold down cost. He himself said the fraud, waste and abuse in Medicaid and Medicare amounted to over $100 billion a year. As for the effect on patient outcomes, dial 1-800-VETERANSADMINISTRATION

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