Romneycare Totally Works
The last few days have seen a rash of stories about how Romneycare is — gasp — working in Massachusetts! The Washington Post‘s Ezra Klein posted a column this morning on the topic:
Over 95 percent of the state’s residents are insured. It’s also popular. A February poll found that 62 percent approved of the law, and only 33 percent disapproved.
Wow: people like having health care! But what about those skyrocketing costs? Fred Bauer, of the Huffington Post, pulled some numbers:
From 2006 to 2010, employer-sponsored health-care premiums for a family rose about 19% in Massachusetts, while they rose about 22% in the U.S. as a whole. Compare that to the period between 2002 and 2006, when Bay State family premiums increased 40% and US family premiums rose only 34.5%. Family premiums went from growing faster than the national average to growing slower than it.
Well, that seems encouraging — costs aren’t increasing as much as they were before. And it can’t be just the recession, seeing that the United States as a whole rose more than the Bay State. How is this happening? Dr. Ralph de la Torre, the CEO of Steward Healthcare, weighed in just the other day, arguing that efficiency from integrated IT systems and “right-siting” are producing enormous savings. Here’s Dr. de la Torre on right-siting, a term with which I wasn’t familiar:
If a patient seeking specialized attention at an expensive academic research center can be treated just as effectively at a hospital near his or her home or office, why send that patient to a premium center? If treatment is available at the doctor’s office, this may be even safer, cheaper, and more efficient. And if care can be delivered at the patient’s home, even better. Each step down to the next rung I have just described yields cost savings of about 20 percent.
Twenty percent savings is an amazing feat in any industry, let alone health care. But it’s tough to get an entire community to go along with right-siting without universal health care. Otherwise, you have uninsured patients taking up costly time in the ER for strep throat and the flu, when they really just need a quick visit to a regular physician’s office.
Dr. de la Torre added more:
We have replaced the fee-for-service model with an approach known as global payments — also called a risk-capitated model. In a nutshell, payers (insurers and employers) give physicians and their staff a fixed sum of money each year to manage the health of their patients. If this in-network medical team exceeds its budget for the patient, the doctors must pay the difference. If the team keeps the patients healthy and has money left over, profit is pocketed. To make sure nobody cuts corners or skimps on necessary care, medical teams receive bonuses pegged to meeting meticulous quality goals. At Steward, 90 percent of patients not covered by Medicare or Medicaid are treated under the global-payment model.
Global payments are another encouraging — and seemingly obvious — development: Instead of paying doctors for running tests and prescribing lots of medications, why don’t we pay them for the health of their patients? And this isn”t some “liberal” approach to medicine: Steward is owned by Cerebrus, a New York private equity firm that believes in profits, first and foremost.
To recap: Universal health care in Massachusetts is popular, has the majority of the state’s residents covered, and is starting to bring down costs. The big political question is whether Mitt Romney — who passed the universal health care law in Massachusetts but who has contorted himself to oppose the nearly identical national Obamacare system — will run toward or away from these results? How can Romney show Republican voters that his signature achievement as a governor is working, when it’s totally anathema to them?