THE 350 PEOPLE who packed into the main conference room of the John F. Kennedy Library yesterday were in a good mood. They were about to hear a report that implementation of the Massachusetts health reform law had, in less than two years, cut the number of uninsured people of working age nearly in half. Then they got the bad news from House Speaker Salvatore DiMasi, one of the progenitors of the law: "The third year . . . will be the most difficult."
The law has resulted in health insurance coverage for 355,000 people, but it is costing more than expected, and it was mainly funded by two uncertain revenue sources: money that would otherwise go to hospitals to treat the uninsured, and a special waiver of federal Medicaid rules. The waiver, which freed up money to expand insurance coverage, expires in less than a month. A renewal seems likely, but it's unclear how much money the state will receive.
And the law hasn't done anything to alter treatment patterns that have burdened Massachusetts with some of the nation's highest medical costs. "We must contain costs," said Senate President Therese Murray. "We must stay together and be fully committed to the second phase of healthcare reform."
A far-reaching cost containment bill supported by Murray has cleared the Senate and is awaiting House action, which DiMasi promised is coming soon. Among other things, the bill calls for more transparency by insurance companies, a statewide system of electronic health records, better recruitment of primary-care doctors, and a ban on gifts from drug companies to physicians.
This last item has provoked opposition from the catering industry. Drug companies would no longer be able to roll out free lunches to attract physicians to informational meetings. But a doctor's prescription patterns should not be swayed, even a little bit, by food or other gifts. Murray's proposal should become law.
A ban on free lunches is nothing compared to the other changes that will be required to make health reform work. Hospitals will need to make sure that expensive procedures actually produce results. Insurers will need to devise payment systems that reward quality, not just quantity of care. Patients will need to be more cost-conscious, especially about unnecessary visits to emergency rooms.
In 2004, when the Blue Cross Blue Shield of Massachusetts Foundation convened the first meetings to solve the unemployment problem in Massachusetts, few would have thought the state could have advanced so far, so fast. The task is still daunting, but the commitment remains strong.