Tackling Health Care Costs

Dave Denison has an excellent article in the Summer issue of CommonWealth magazine on the lack of attention paid to controlling costs in last year's landmark health care reform law. It's becoming apparent as the state works to implement that law that it does little to address the rising costs of health care and there's little political will to change the status quo, even as cities and towns, not to mention private sector employers, struggle to keep up with those costs.

The cost argument at the time, if I recall correctly, was that if we were able to achieve universal health coverage, costs would magically lower themselves as hospitals would no longer have to cover the costs of care for the uninsured and people who would under other circumstances end up in the emergency room would now be able to afford to go to a primary care provider before a health situation worsened (and therefore became more expensive).

Of course, if that were the case, Massachusetts should have already had low health costs. Even before the new reform law took effect we were already insuring 90% of the population, which was enough to put us in the top ten, tied for fourth with five other states. If a low percentage of uninsured individuals was enough to keep costs down, we should be among the lowest cost states, not the highest.

Denison notes that the group nominally in charge of reducing costs is the state's Quality and Cost Council, but according to the article, they are focusing on creating a public database of local health provider costs and, presumably, outcomes. That, however, is still in the brainstorming stages and won't see the light of day for another two years according to council member Charlie Baker. I for one remain unconvinced that individuals would use such a tool to comparison shop for doctors or hospitals. Baker points out that the real benefit would be in third parties, such as insurance companies, legislators or journalists who would use such a database to ask tough questions of care providers that were out-of-step with the rest of the market. It seems to me, though, that we're relying on those very people right now to ask these questions, and they don't seem to have the stomach to come up with answers. A database would be nice -- more sunshine on these matters would be a good thing -- but don't our legislators have the power to compel providers to give them this information now without linking it to a public database? Don't insurance companies have the incentives and the leverage to get this information from hospitals? Why do we have to wait for the state to put together a big web-enabled database that we can search ourselves if the savings are going to come from experts using that data anyway? Could we not get those same results just by commissioning a study of current costs and investigating the differences between providers?