Taylor Armerding

Obamacare is off the front burner.

The president still insists it is still going to happen, but he has moved on. Given his recent rhetoric, one of his biggest jobs right now is to erase our memory of what he spent most of his time doing in 2009. He wanted a health care bill on his desk by August. Then he wanted it before Christmas. Then there was no rush. And now his top priority for 2010 is jobs. He wants a jobs bill on his desk soon — probably well before August.

Fine with me, although the only jobs Obama appears to care about “creating or saving” are government jobs. I figure maybe the feds ought to make Social Security solvent before they take over a sixth of the economy.

But we in Massachusetts can’t move on. We’ve fallen into Romneycare and we can’t get up. We have our own universal health care. And while it supposedly is a triumph of “access,” since 97 percent of the state’s population is now reportedly insured, it is sending us from the poorhouse to the brokehouse. It is definitely bending the cost curve, but in the wrong direction.

So a 20-page report from the office of Attorney General and recent unsuccessful U.S. Senate candidate Martha Coakley, released about a week ago, should have made a much bigger splash than it did. Universal health care in Massachusetts may be sending more of us to the doctor, but it’s croaking us financially.

The problem is obvious: “Health care costs are increasing much faster than the growth of the economy,” Coakley said in a press release.

You think?

We won’t go into how this breaks the glowing promises made in 2006 that not only would universal health care save lives and improve care, but would “bend the cost curve” down. That’s a column for another day.

But the report also confirms what has been suspected for a long time — bigger is not necessarily better in health care. Nor is more expensive necessarily better. Sometimes, more expensive is worse.

Put another way, in some cases we pay Lexus prices to get Corolla care. In other cases, we pay Corolla prices for Lexus care.

Even worse, the AG found compelling evidence that higher prices aren’t due to more complexity of care, sicker patients or any of the other things that most of us might find reasonable. The institutions that charge more do so just because they can — because they have what the AG calls “market leverage.”

Of course, one of the reasons this happens is because we don’t see it. Only our insurers see it. We just pay our premiums, deductibles and copays, grumble about how it gets worse every year and blame the evil insurance companies, even though they are the weaker player at the moment in the perpetual cutthroat struggle between insurers and providers.

Unfortunately, even if you read the AG’s report, you won’t see who the good guys and bad guys are. That’s because the 2008 law that gives the AG the power to collect information that both insurers and providers are loathe to provide, also requires that she keep it confidential.

Still, the findings are explosive. Among them:

• The prices insurers pay for the same services vary wildly, by more than 200 percent in some cases.
• Higher prices are not due to quality of care, the complexity of care, a higher Medicaid or Medicare population or the fact that an institution may be a teaching or research facility. They are largely due to market leverage — institutions that are much bigger and more powerful than others, that have better “brand identity” or that are geographically isolated. Their costs may be similar, but they have the power to charge more. So they do.
• The enormous increase in health care costs since the beginning of universal health care in Massachusetts is largely due to price increases, not overuse of the system.
• Price disparities are kept in place, and in some cases get worse, because of deals made between insurers and providers that stifle competition.

Ironically enough, the report calls for “more transparency” about price and quality. This, in a report that features a glaring lack of transparency. Of course, the AG has legal cover: It’s the Legislature’s fault.

Also ironically, former Harvard Pilgrim Health Care CEO and current Republican gubernatorial candidate Charles Baker has been calling for transparency for the past five years, for the same reasons.

But yeah, it would be very helpful to know that the success rate for knee replacements is better at the community hospital five miles away than at the much more expensive metro teaching hospital 40 miles away.

There is a way, however, to make the information about individual institutions public. The law allows several exceptions to the confidentiality rule. Among them is one that allows disclosure in certain public hearings. Another allows it, “if the attorney general believes that such disclosure will promote health care cost containment goals …”

Incredibly, the AG won’t say yet what she “believes” in this case. A spokeswoman for Coakley would only say that it is a “policy matter” that will be decided in the coming weeks.

The Legislature will hold public hearings on the report beginning March 16. If you care about the cost of health care — and you should — tell your elected representatives that you demand transparency in health care.

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This entry was posted by Adam V. Russo on Tuesday, February 9th, 2010 at 9:01 am and is filed under Health Care Legislation. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.