Wednesday, January 31, 2007

Municipalities in Health Care Crisis

Northampton mayor Mary Clare Higgins and Ralph White, the president of the Retired Massachusetts Employees Association, jointly wrote an op/ed in yesterday's Globe describing the crisis in municipal health insurance. Their remedy is to allow municipal employees to join the state's Group Insurance Commission, and they urge passage of a bill filed by friend-of-the-blog Rachel Kaprielian (D-Watertown) and Richard Moore (D-Uxbridge). The Group Insurance Commission currently provides health insurance to more than 285,000 government employees and their dependents, and as such it potentially has more leverage than would an individual city or town. The sticking point, it seems, is that municipal unions are not keen to lose their collective bargaining power for their members' health care. Higgins and White explain:

Some cities and towns would prefer to join the Group Insurance Commission without consulting their employee unions, but they recognize this would have trouble passing on Beacon Hill. Some labor leaders wish to maintain their current ability to bargain over the design of local health plans. Nevertheless, they recognize that the state system may be an attractive option anyway because its superior purchasing power can lead to better plans at lower cost. The commission itself is used to having a single "split" -- with a fixed percentage of the premium coming from the state and the remainder from the employees -- but the panel has agreed to allow each city and town joining the system to decide its own local split. Cities and towns agreed to continue bargaining over that split with their employee unions.
I agree that there is a health-care affordability crisis in cities and towns. Just yesterday Watertown Town Councilor Jon Hecht painted a bleak picture of the situation here in town:
"Without some sort of cost containment on healthcare, there's no way we can achieve the other objectives that are in these budget policy guideliness. We will not only not have money for new programs, like streets and sidewalks or a recreation center, we may face the need for cutbacks in current programs."
It seems to me that there should be no reason municipalities should be prevented from joining the Group Insurance Commission, but we should not expect this to be a long-term solution. The health insurance crisis is not going to be solved by getting everyone onto a cheaper plan. Without some sort of system-wide cost containment, we're just putting a band-aid on the problem. For all the hoopla around the new health insurance scheme, it's becoming clear that we can't just pretend that costs will go down if only we just tinker with the system a little.

In other health insurance news, David still hates the individual mandate. I'm starting to agree.