Aug 2, 2012|
Joshua Archambault is Pioneer’s Director of Health Care Policy & Program Manager for the Middle Cities Initiative stopped in to fill in Todd and the WRKO World about the new health bill.
Transcript - Not for consumer use. Robot overlords only. Will not be accurate.
Good morning going to be hot low eighties mid eighties. Mix of sun and clouds today may be some rain in the afternoon. It's not -- show brought to buy network capital funding corporation your future financed. Sadly we're going to leave chick -- for a little bit but there's important stuff going on otherwise like here in the state. There is a new law about a new -- coming about healthcare. That will change all kinds of stuff this price fixing in here. There's all your favorite socialism does everything you want and healthcare bill. Here to talk to us about a break instead break it down forces Josh -- arch from beau he's the director of health care policy. At the pioneer institute a terrific thinks the think tank in the city. And Josh welcome back to WRKO thanks for being here and -- have -- so what's going on what's this latest salvo is this the the second leg of Health Care Reform the first leg was. Let's get everybody on board with a broken system and then some year down does some years down the road we can try to figure out how to make it affordable is this that second piece. Yes about the rhetoric there were hearing on beacon on this is how to reform 2.0 and just to be really clear for your listeners we -- not talking about the federal health care while Obama care and Affordable Care Act. Not talking about Romney counted -- expert. That was passed just on last night part two nights ago in the legislature. And is now sitting on the governor's best guess ten days to act on it in this thing is huge to sister about 350 pages long. Just relevant context to 2006 Romney care law. About 86 pages so this is much much bigger is stunningly -- -- -- -- it was -- and I thought while that's gross at 350 page bill but then we think back to obamacare which was 2700. That I -- -- certainly as you can imagine there's no acting here. Those of us that are -- following this have just to try to been digging through it in just a note on the process and this -- and -- giving example how on transparent and undemocratic this whole bill process ones. They released this 350 pages at 1045. The night before there are gonna vote on sixteen hours later no debate. And they voted on it right away and and I had to be honest. Monasteries seems to me as a voter and as a future patient in our healthcare system the members of our legislature. By and large had no idea what their voting which are perfectly happy to do apparently because if if it comes up with ten minutes to vote before the vote. Then you -- you don't have to read it and I right now -- out that's true follow their logic now. In a normal world you would expect them all vote no on it because they have -- you would think so and and to be honest there was only one Democrat that -- stood up and revenue -- -- from Wilmington -- deserves a lot of credit he stood up on the floor and said. Look I feel really uncomfortable voting for something that I haven't had a chance to look through. That people without a financial interest have raised concerns about and to his credit he was the the only member. Through this entire process Republican or Democrat. That stood up and said I will not vote -- this is the process is on transparent it's and he deserves a lot of credit and he then voted against he did vote against it and now I'm just to give a sense for. Where folks came down on as I'm in that senate again there's forty members in the state senate. The first time around -- voted against it it was unanimous had the second time around. And then the house that went from seven no votes to twenty no votes have some folks got the message that there's something wrong here. Now about the process but actually the contents of that pale light as they obviously like it. If there are voting for what does the build do. And why would anybody support when it does so what then members say they supported is that the title includes cost containment and payment reform and health -- so they think. And authors of the bill have promised that were going to save 200. Billion with a B billion dollars over the next fifteen years. On average seat to -- and higher gonna say the average friendly 2000 dollars on that before area yet per year that's our remaining. Now that's very real well is about as good as a big big costs and 2.5 billion that's right that's right and when you dig a little bit deeper about how. How do we actually how we gonna save that money. If you asked the authors. -- -- And in what they say player what they what they say is a 200 billion dollar is what they. Hope to say okay so this is you take every idea that anyone's ever had it might or might not actually. Lower the costs of healthcare throw it into a pot mix it up. And hope that the result is best case scenario saving them money. That's what they hope unfortunately down one idea that they left out one and we abdicate very strongly is actually engaging the consumer that's the one element that that kind of laugh out there transpires one of the problems right now is. We don't see any of the costs as I understand it. It's not even legal if I call my doctor and -- sent -- to the MR place that has the lowest prices which one is that they won't tell me. They say because they're forbidden by law so it it seems obvious. That he at least if I had a shot. At having choices at -- place across my insurer at least I would I would wanna do that yet so this is one example which -- half step in the right direction and a lot there is a lot and this new state law about transparency trying to get her. Both doctors and physicians and hospitals and insurers to give you the price information. Here's the concern why it's only a half step in the right direction. If I am a consumer. And I go and I asked my doctor how much is this knee surgery and they say it's gonna cost 4000 dollars. Let's say I'm really entrepreneur and I called a hospital down the street is an action and 5000. If my insurance plan. Only makes me a ten dollar scope -- hundred -- -- regular vote for the most expert I'm a go to the most expensive that's exactly -- -- we see -- if all you have to do though is -- -- kickback. So if the insurer is allowed to give me a 10% bonus. Four or 5% whatever 5%. Of that 4000 dollars for go to the cheaper place would not be excited about this that I've got skin in the game both directions yet you -- actually we've seen this guy not to pitch one insurance company about Harvard pilgrim has started a product. Someone along those lines if you called this hotline and you asking you find a cheaper thing will give you a little bit of money though. You decent cash back. That is it that's the direction we need to have unfortunately this bill doesn't really get you there it's simply says what we're gonna mandate everybody says how much things cost. But yet as we just described and we saw this and in our governor just about a year ago when he needed some work done where did you go MGH one must expense of hospitals. In Boston because she equates -- at a higher price of higher quality in my concern is that there are so many people that will follow that example. And then instead of lowering costs and cost containment as they claim that's in that spell you're gonna see the opposite a lot of folks are gonna go to go to those costs higher cost providers. But that's not the most egregious stuff and -- but this. Seems to be I mean you cover exclusively for pioneer you focus on health -- were talking with deep discharge our sham bow from. Not a pioneer institute and so you study this full time but you must see a lot of legislation though by. Is this normal for legislation to be garbage to just throw whatever trash you have and put it under -- great name him. That's we saw what the national bill as well it wasn't awful distorted piece of legislation that wasn't designed to be good or effective because they never thought the senate version of this slow the bill would become law so they use the bill as it as vessel through which they threw anything anybody wanted that they -- bribe a senator to vote for it. And that's the law we have. This statement it sounds like your same MI -- it is as tortured process. But it's the same idea -- lot of goody two shoes -- ideas about things it would help. Healthcare that are the ideas of the moment right like this some this idea that you built based on the patient rather than on the procedure what's that called. -- moving toward decapitated or global payment yeah where -- have a set amount of money for the procedure. I -- what's different here is that often at the state level compared to that of the federal. Is that they actually try to get it right now did Iditarod sometimes yes I mean I all I have as a contract context here is looking back -- 2006. When we did our health reform and regardless of how you feel whether it's worked or not. There a process there we had language people weighed in over a year. And they got a chance to kind of take a whack at it and they've had a chance to see how it's played out in implementation and there was a real robust discussion. In this bill. Again like I sent 350 pages there was no and I mean no debate in the House of Representatives about this actual -- be debated some amendments but not yet. So this was a -- when they got the things the night before. What was this Tuesday night they got the legislation I guess standard of -- on Tuesday and got -- Monday night my day and night and they voted Tuesday on about basically that it would mean humanly possible to have read and absorb three -- -- fifty page are you saying. There was no -- committee process that led up to that legislation being created there is no knowledge and there. So so what they did wise and again this is a great example of legislative success replied public policy failure. They spent a year and a half doing all sorts of meetings. And then they released language they vote on it really quickly the first time and the house and senate had different versions of a set up that's behind closed doors six. Member -- -- went to conference went to conference and said they were to hash out behind closed source port of the differences. That report which resulted in the -- fifty pages was released at 1045. Know debate up and down vote no amendment as it moves. Nobody knew what happened to the house bill -- passed in the senate bill account pass when they emerged into a single bill. The people voting on the final version didn't have a chance to absorb it. This could have been that chick filet appreciation day legislature for all they knew it once you've -- down until politely. They -- about -- when members were asked by the press who we you know how do you feel about dispel these are the people that were voting for they said I'm still forming my opinion. I still trying to understand it I'm voting for it and EMI contention here is look I I've worked used to work in the building I understand networks they don't read every single pale. But when you have something that the language is this is historic its transformative we're gonna save 200. Billion dollars and fifteen years. I want them to have a basic understanding what's in that and when I delve into this I'm still -- making my way through a I've read all the earlier versions. There's hundreds of millions of dollars of new surcharges fees and penalties that are in here that will be passed on to consumers. And bureaucrats are given a tremendous amount of power which I think. So who wins. Bureaucrats win bureaucratic government wins big government wins so that's one reason why. The majority on Beacon Hill would be thrilled with the new health -- -- who else is there anyone who's obviously a victory. Is our money trail here we can see all this is great for us here on on Beacon Hill because. The hospitals will be happy or whatever. -- that your -- of Wright State government and aircraft -- huge in -- -- -- they are not at risk for any of their decisions going forward and they have almost complete oversight. Over at any number of things and we can talk about what are some of those things that are a little scary that could increase costs and decrease quality. But ultimately my concern is that in our state we have dominant. App provider groups yeah the recent market share issues like air Mass. General for inserts for instance that's one example. And what this legislation does is simply speak. In the inequality it doesn't address it in any meaningful way. So they set these artificial growth rates again -- say we want health care spending to increase the same amount as our state economy. Well everybody's gonna grow at the same amount but not everybody start from the same place. And so these are freezes in place in essence -- -- is big now will remain big whoever is small we'll have trouble growing the correct because they're going to be on punished. If their billing goes is that how it does it even explain how they're gonna measure that one of the interesting things about the slot as it tries to control I -- interesting in the form of if you want to design a disaster. Taken industry make a law that says you guys aren't allowed overall to have your costs go up more than X percent every year. Now this is if you believe in capitalism this is the greatest evil. That government has ever invented but have they even said what the mechanism is to measure growth -- -- five grow might might total billing because I've added patience and I -- get penalized for that. No -- so they are they do try to be a little sophisticated about this in trying to say well if you have sicker patients if you get more patients were gonna adjusted per capita or per. Per patient so it's not quite that -- However the concern here. Is that these individuals in unless you engage consumers to pick that low cost high quality provider they're gonna just keep going to these folks. And they're gonna outlast all the smaller providers. And with the added kind of bureaucratic layers here. When you have a new -- since if you got a new procedure that's gonna save a lot of money. The state over seas and authorizes but it can be rolled out and that is a little scary to me. That this state I'm gonna expect a state bureaucrat to understand what is the latest and greatest. And what should be approved going forward in our state at that that is concerning amazing and I hope it's -- -- for a markets totally out of the health care business that's right and and I think we just need to be really clear that well. Just call the Soviet Union and say is nick is Nikita are around. Is land had available we were looking for ideas because that's what this stuff sounds if you want to destroy the vibrancy of an industry. What's unique about health care in Massachusetts. Is were on the cutting edge of it and how are you at the cutting edge if you don't have market forces. Guiding people on where to go hang on Josh will continue our conversation after a quick break the Todd Feinberg showed WRKO. Todd tiger -- WRKO Josh are Sambo is here from. The pioneer institute he is their health care expert there is a new -- coming down the pie in front of all and the economy's up on Beacon Hill. And this -- designed to destroy health care instead of Massachusetts. Although that's not the name they've given what's that it's got a different name that's a little more and subterfuge and -- cost containment payment or -- cost containment cell. You're gonna give us an analogy for how to understand what's going. I think there's two kind of easy where health care can often get very complicated quickly ever but I just when I talk about it and two very simple ways for talks to think about it. You know if you live what they're trying to do here to computers for example you wouldn't have all the apple products that we do. You know your artificially sang health -- can grow and X amount he can charge X amount for this. Okay I'm offended at a cost like 300 bucks to get an iPod Touch. And what I did you get I was governor. Yeah I'm the governor so I can pass a law saying iPod touches that the cost of them. Can't grow more than the the inflation rate of the economy that's right and so their thought -- they're thinking and their logic as well then everybody will be able to afford not part touch. But I think adding to concern here long run is the next generation of iPod touches would never be developed. Because there are no longer an incentive for folks to do that -- and on health -- this is I think. I don't want would be too hot and you so much hyperbole here but this is somewhat of -- life and death issue for a lot of it is because -- if there's any caveat it's that you can't know. Exactly what kind of damage they've built into this thing because they don't know they've simply written a piece of legislation that no one's -- And in the -- Who knows what time bombs have been designed -- may not even know what wonderfully frank and -- and destruction their gonna -- I think that's exactly right and so much of this language that I've read in a -- says -- future regulators -- state bureaucrats. You figure it out to everyone went something's on reasonable and something's excessive. You know do what's appropriate and if you -- Asian law -- they love. The regulators -- it is nothing more undemocratic. In the world than this kind of legislation you take money. And you take jobs and you assign them to a bunch of bureaucrats and nobody sees nobody knows they exist. And they simply issued decrees that's right and and and the additional concern is that it opens it up to lobbying no longer do lobbyists have to work -- all members of the legislature of the general public they can focus all of their effort on. Eleven people were set on a commission to make these decisions. Just the other second analogy all users. Austin what's done in this bill it's it's kind of like that balloon that you make balloon animals where they see a problem they try to squeeze it whether regulation or government action. But what happens there's a distortion somewhere -- so then they try to squeeze it over there -- another regulation or government action. And the concern here is two things either you're gonna continually be looking for the distortions where that picture errors going or get a pop the balloon. So I think as citizens as patients we all go to hospital we should ask our state representatives state senators what did you just vote for. And how which is actually gonna save -- -- 200 billion dollars that's offs of I'm often lofty rhetoric here and how much we're gonna say it. And in the process -- -- have state bureaucrats deciding where you get your care and how to pay for so I think it's legitimate to race and concerns here he is all done. Kind of behind closed doors -- about real any debate about it and I just it's very frustrating to me and I am concerned about the ramifications on what do you have any sense say is throwing out your line of work novel is wondering about the motivation is is there or somebody. It behind this who actually thinks. That making this an unelected bureaucratic rule controlling health care. Is going to add to the vibrant of health care in the state of Massachusetts -- I think they think well were removing it from ourselves we're taking out of the political process and gain politically. Because they're not responsible I think there's a letter of credit that they can point the finger at somebody outs and say look we've done everything we can we pass this massive -- we set up bodies. Expert commissions and advisory councils and boards and look they still can't even figure it out. And from my perspective you know what it's really easy to solve this problem there's some very Smart people that have. Some interest in this it's called the consumers so let's make sure that we engaged and give them information that they. Have they just say NHR -- and FSA has also let me did these are all of them mechanisms you know and it just for example HSA is -- savings account ticket Deborah card. For the first time ever when somebody gets a house savings account they're spending their own money and they feel it. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- Right now -- a hundred dollars for our procedure. Anywhere they go so -- we don't have any information and we don't have the incentive because we pay a fixed price we get no bonus I would love to get a bonus from my health care provider. From my health insurer if I was choosing to go where I'll drive an extra ten minutes or twenty minutes to save some money. And get a little kickback that's right and that and I think you know we hopefully if there's any silver lining of this legislation may be. Some of that information become more transparent here but there's been efforts in the past part of 2006 -- And other laws that they passed since then to try to get more transparency in the system and you know what the state has slowed that procedure. To get that data it's now six months to a year old you have to put in an application may have to approve it don't watch it and I. He said that's the concern here you know we've seen this before and a lot of their proposals that are in this we've seen. I mean if they have this new guy accountable care organization idea you know what it's HMOs by different name. And so I I think the concern here's all the levers that they're trying to push. We've seen -- I'm still setting an directive for citizens when you see your stay around and state senator and make an effort to do it. Ask them to explain exactly. How this legislation works how to fix this health care in the state of Massachusetts and then after they can't answer that question except by feeding you'll platitudes. Asked them why they would vote for something they understood so so little that's right and I think simply saying why did you take this -- the next legislature -- the next session and and it seems logical and such a complex issue deduction wanna get right to just say who's voting against -- is running against you because I wanna give them a donation could you point me in the right direction. A Josh how to people learn more from a pioneer institute resource so I would -- the -- resource right now is taking going our blog I've been blogging on this throughout the whole process it's pioneer institute dot org back slash blog. Or they can feel free to contact him Josh at pioneer institute dot -- awesome thanks for coming in today except it's always good we learn a lot coming up. We're gonna talk about a decision by the Democratic Party to put gay marriage on the official platform. Will have an expert on the matter here doctor Michael Brown so stay -- to 680 WRKO.