Health Care

Unions Mobilize As House Considers Collective Bargaining Rights

By Sarah Birnbaum   |   Tuesday, April 26, 2011
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Apr. 26, 2011

BOSTON — The Massachusetts House is one day into its deliberations on a controversial budget would give cities and towns the ability to change employee health plans without union approval.

On Tuesday, union officials milled about the State House hallways, wearing buttons that said "collective bargaining = affordable health care." They passed out leaflets to House members as they entered a closed-door caucus to talk about the budget.

AFL-CIO president Bob Haynes says unions are working to avoid the kind of measure that stripped their counterparts in Wisconsin of their bargaining rights.
“All these public sector unions want to do is be able to negotiate their health care plans. We don’t want to be like Wisconsin. We want to make sure we have the right to be at the bargaining table," Haynes said. 

House Speaker Robert Deleo's plan would limit public workers' collective bargaining rights on health care plans. Deleo’s proposal would allow cities and towns to raise health insurance co-payments and deductibles for firefighters, teachers and other local government employees without prior union approval.

Union leaders are gathering support for an amendment that would require some negotiation with unions before health plan changes could be made. About 50 Democrats have signed on so far, including some members of Deleo’s leadership team.
Deleo’s backers argue that municipal workers have some of the most generous health insurance plans in the state, and the costs are unsustainable.  They say that  employee health care costs are draining local budgets and crowding out funds that could be spent, for education and other municipal services.  Debate on the amendment is expected over the next few days.

Mass. Health Care Law Turns Five

By Sarah Birnbaum   |   Tuesday, April 12, 2011
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On Apr. 12, 2006, Massachusetts Gov. Mitt Romney shakes hands with Mass. Health and Human Services Secy. Timothy Murphy as Sen. Edward Kennedy looks on at after signing into law a landmark bill designed to guarantee virtually all Massachusetts residents have health insurance. (AP)

BOSTON — Massachusetts' landmark universal health care law turns five Tuesday. State leaders are celebrating the occasion -- and some are using it to point out that it was passed by then-Gov. Mitt Romney, who is expected to run for the GOP presidential nomination.

At an event on Tuesday, state Democrats rolled out a white cake that read, "Mass. health care a model for the nation, thank you Mitt." The law, which requires all Massachusetts residents to have health insurance, was signed by Romney in 2006. It's a move many see as a vulnerability for Romney as he works to increase his appeal to GOP voters, who are generally against President Obama's health care reform package, which was modeled on the Massachusetts law.

Romney, for his part, has defended the Massachusetts law, but said he never intended it to be extended to all 50 states.

Massachusetts Democratic Party Chairman John Walsh also paid a more serious tribute to the law, saying it has increased coverage of children and helped decrease racial disparities in health care quality.

At an event marking the anniversary on Monday, Governor Patrick said that thanks to the law, more than 98% of Bay State residents have health insurance.  And he proudly noted that Massachusetts health reform laid the groundwork for Obama’s health care overhaul.

 But Patrick also said that more work needs to be done to make health insurance more affordable.
In the coming weeks, the Legislature will hold hearings on a number of health care cost containment measures, including a controversial plan called "global payments" that would change the ways doctors and hospitals get paid.

At Forum, Patrick Stumps For Global Payments

By Sarah Birnbaum   |   Wednesday, April 6, 2011
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Apr. 6, 2011

BOSTON — Gov. Deval Patrick is renewing a push for lower health care costs. On Tuesday, he convened a State House forum on the issue. 
The governor opened the meeting by calling on lawmakers and health care interest groups to rein in the spiraling costs of health care — and to do so quickly.
“We are going to have to solve this problem together. And we have got to stop being defeated by the complexity of it," Patrick said. "Because while we ring our hands about how complicated it is, there are small businesses and working families and working communities going under because premiums keep going up at an unsustainable rate. And you know it.”
Patrick filed a bill back in February that he says will help reduce premiums by changing the way healthcare is paid for. It would move from a fee-for-service system, where every test and procedure is paid for individually, to what’s called “global payment.” 

That means doctors and hospitals would be given a yearly budget for the care of their patients, and therefore would have an incentive to keep them healthy and out of the hospitals, and not to order unnecessary tests. Patrick says that if this bill passes, Massachusetts will lead the nation in health-care cost containment.
But Lora Pelligrini is not convinced. She heads the insurance company trade group, the Massachusetts Association of Health Plans.
“The attorney general in her report last march showed us that providers who are globally paid are some of the highest-paid providers in the state. So paying globally isn’t the panacea,” Pelligrini said.
Pelligrini says a bigger problem than the way doctors and hospitals get paid is that large, name-brand hospitals can charge more for care without necessarily delivering higher quality medicine. She says Patrick should focus on ways to curb the negotiating clout of large hospital groups. 
The cost-containment debate now moves to the Legislature.  A first public hearing on Patrick’s bill is scheduled for May 16.

Report Offers New Recommendations For End-Of-Life Care

By Sarah Birnbaum   |   Tuesday, March 15, 2011
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Dr. Joel Policzer checks on Walter Norton in the hospice wing of a Fla. hospital in Oct. 2009. Most of Policzer's patients have made no end-of-life decisions. Some officials in Massachusetts want to encourage a more deliberate decision progress. (AP)

BOSTON — Massachusetts doctors and policy-makers are calling for new guidelines on end-of-life care.

A report released Monday by a panel convened by Massachusetts health officials says that all too often, doctors don’t discuss end of life care with their patients.  And as a result, patients are likely to receive costly and unwanted hospitalization and medical interventions.

The report makes a number of recommendations. It says doctors should be required to talk with terminally-ill patients about their wishes for their end of life care, and that doctors should be required to inform their patients about all their medical options – including palliative and hospice are. Health insurers, it recommends, need to compensate doctors for these conversations.  

Dr. Lachlan Forrow is the director of  palliative care at Harvard’s Beth Israel Deaconess Medical Center and the chairman of the
end of life panel. He says the panel was guided by three principles.

"Individuals should always be informed of the full range of the ways they should be cared for. Any preferences they have should be documented and always available when medical decisions are being made. And those preferences should always be respected," Forrow said.

But some patient advocates worry that patients might be pressured into accepting palliative or hospice care over more expensive, life-sustaining treatments. And others say that while its fine to have conversations about end of life preferences, many patients don’t have the resources to get the kind of care they want.

The panel’s recommendations are non-binding, and the report provided no analysis of costs or benefits to making easier for terminally-ill patients to choose home care or even to die at home.  

The report comes as Vermont lawmakers consider a bill, supported by that state's governor, that would allow some terminally ill pateints the option of a lethal perscription, obtained by their physician.  

Your comments: Have you supported a loved one through end-of-life care? Did you feel informed about your options? What can health professionals do to communicate better?

Simple Steps To Improve Weight, Memory, And Mood

Thursday, March 10, 2011
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Mixed Reaction To Patrick's Health Care Reform Bill

By Sarah Birnbaum   |   Friday, February 18, 2011
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Feb. 18, 2011

BOSTON — Massachusetts Governor Deval Patrick is filing a bill Thursday that aims to reduce health care spending by changing the way doctors and hospitals get paid.  Most insurers and health care providers reacting to the bill are positive, but cautious.  
Patrick's bill would move the state toward a so-called “global payment” system, where doctors and hospitals receive a lump sum per patient, plus bonuses for keeping the patient healthy, instead of getting paid for every office visit, test and procedure.  The governor says the change will save money, because there won’t be a financial incentive for doctors to order unnecessary and costly tests.

 Blue Cross and Blue Shield, the state’s largest health insurer, is already paying some doctors this way.  And Blue Cross CEO Andrew Dreyfus says the system is working.
“Quality is going up, costs are coming down, and I think as those experiences are understood, people are actually going to see – this is a better system,” Dreyfus said.
Dr. Alice Coombs is president of the Massachusetts Medical Society.  She says one in five Bay State doctors are already in a global payment system, but she says many other doctors are worried they won’t be able to afford new electronic health records which would be required under the new system.
“They want to know what do I need in order to do this? They need the bells and whistles, the infrastructure, if you will, the electronic medical records and those things… it takes capital to get there," Coombs said.

Health care providers and insurers say the way forward will be complicated. Earlier this week, the state’s largest union representing healthcare workers recommended that changes to the payment system should be made gradually.

Health care advocacy groups, however, have urged lawmakers to act quickly, saying the recession has led to a jump in the number of people struggling to pay health care premiums.

About the Author
Sarah Birnbaum
Sarah Birnbaum is WGBH News' State House reporter. Send her a news tip.


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