Friday, November 18, 2005

Slowly, Slowly

Possibly because it thinks itself the pinnacle of all things medical, health care stories seem always to be of more interest in Boston than elsewhere. Prodded by Governor and would-be-President Mitt Romney’s current initiative to do something about the uninsured, the November 11, 2005 issue of the Boston Globe devoted its entire Op-Ed page to what it headed “The healthcare debate.”

The page included six presentations, representing

- an advocacy group favoring an employer mandate
- a health care provider organization
- the state hospital association
- an advocacy group opposing an employer mandate
- a professor of health policy and management
- an employer favoring an employer mandate

As can be seen from these headings, much of the debate was about an employer mandate; i.e., a requirement that employers of a certain size or larger either provide a health care plan for their employers or pay a special tax.

I found two things interesting:

- Support for an employer mandate continues to grow. More than one writer pointed out that since payments to providers are covering the cost of unreimbursed services provided to the uninsured, employers who provide health care plans are subsidizing those who don’t.

- Three writers mentioned the importance of getting the cost of providing care under control. Charles Baker, head of Harvard Pilgrim Health Care (the provider organization) made that his first and most important point.

An employer mandate can be legislated. Cost control is not so easy. The professor (Joseph P. Newhouse) said it was possible but an issue for another day. Baker thought the will to deal with it existed but awaited better information. He also remarked that affordability will drive sustainability.

There seems to be a growing realization that an employer mandate is necessary but its achievement depends in part on bringing cost under control.

Slowly, slowly, health care reform is happening, even if the pace is agonizing.

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