Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Alan Sager, PhD, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, 617-638-4664, asager@bu.edu and Deborah Socolar, Health Reform Program, Boston University, 715 Albany Street, Boston, MA 02118.

In 2007, Massachusetts will pass two milestones. It will begin implementation of a new law that is said by its sponsors to cover 90 percent of the people lacking health insurance. And health care spending per person will pass $10,000 yearly, one-third above the U.S. average.

Hospitals and other groups try to deny, rationalize, or explain away our higher costs. Some of these justifications are legitimate. Most are not. Even if hospitals and others could justify these costs in some statistical sense, the financial reality remains that health care in this state is becoming unaffordable for citizens, employers, and taxpayers.

Family health insurance premiums are about $14,000 yearly in greater Boston, up an average of 10 percent yearly for the past decade.

If this trend persists, family premiums will be over $22,000 in 2011--just 5 years from now.

Failure to contain cost threatens coverage for everyone who still has it.

And failure to contain cost will make it much harder to implement the already under-funded promises of the new Massachusetts health insurance law, chapter 58 of the Acts of 2006.

Massachusetts health care is addicted to more money for business as usual. This is starkly unaffordable. In a few years--perhaps at the bottom of the next recession--there will not be nearly enough money to finance the types of care our hospitals, doctors, and other caregivers have become accustomed to giving.

This state badly needs a health care financial disaster plan.

But there's more good news than bad. One-half of current health spending is wasted. Much of the waste can be squeezed out and recycled to protect uninsured and under-insured people, hold down premium increases, and boost quality of care.

Squeezing out waste will require a new type of cost control, one that rests on serious negotiations with our state's doctors. Here's why-- No past cost controls have worked. Many doctors here are hurting. Their gross incomes in this state average 30 percent below the national average (partly because we have so many doctors), and most of the rise in doctors' incomes goes to practice expenses. Doctors' decisions control almost 90 percent of health care spending. It is their patterns of care, especially for supply-sensitive services, that engender much of our state's extraordinarily high costs. Only state government can begin the job of negotiating new arrangements with doctors. It must begin the job soon. Smart gubernatorial leadership is essential.

Learning Objectives:

• to follow...

Presenting author's disclosure statement:

Any relevant financial relationships? No