The head of Partners HealthCare System, the state's largest and most influential hospital and physician network, today issued a public appeal for higher taxes and mandates on employers to cover millions of uninsured Americans.
In an article in the New England Journal of Medicine, which has 500,000 readers in 177 countries, Partners chief executive Dr. James Mongan and Dr. Thomas Lee, president of Partners' physician network, challenged doctors to advocate for increased taxes and laws that would require all employers to provide health insurance coverage to their workers.
Mongan and Lee didn't calculate costs, but in 2003, the Institute of Medicine, a nonprofit healthcare advisory group based in Washington, D.C., estimated that it would cost $34 billion to $69 billion annually for complete coverage of the uninsured.
''How can a country as idealistic and generous as the United States fail repeatedly to accomplish in healthcare coverage what every other industrialized nation has achieved?" Mongan and Lee wrote. ''One explanation may be that we are not so idealistic or generous as we would like to believe we are."
In an interview, Mongan and Lee said their article is intended for a national audience. Mongan has spent a good part of his career working on expanding healthcare coverage for the poor, at one point helping President Jimmy Carter write a national healthcare plan in the late 1970s. Mongan said that while Americans and their elected officials say they want coverage for everyone, they shy away from paying for it.
''We really wrote this for our colleagues, to say if you're serious about wanting to make the healthcare system work for everyone, you can't just complain," Lee said. ''You have to be willing to advocate for things not pleasant for people to hear."
Their article comes at a time when Massachusetts Governor Mitt Romney and the Legislature are preparing to debate whether and how to expand healthcare coverage to more than 460,000 uninsured Massachusetts residents. Both Romney and Senate president Robert E. Travaglini, the leader of the healthcare drive in the Legislature, have ruled out higher taxes and requiring employers to cover their workers.
Partners executives are deeply involved behind the scenes in the Massachusetts debate over coverage for the uninsured and are meeting with business leaders and legislators to discuss their views. Partners, the parent organization of Massachusetts General Hospital and Brigham and Women's Hospital, also contributed $100,000 to the Blue Cross and Blue Shield of Massachusetts Foundation's Roadmap Project. Under the project, the Urban Institute, a nonprofit research organization in Washington, D.C., is developing a plan to cover the uninsured for Blue Cross's charitable foundation. The group could end up proposing the ''road map" or parts of it as legislation.
In their article, Mongan and Lee acknowledged that any new funding for healthcare coverage would flow to hospitals and doctors like those in the Partners network. They said they felt compelled to mention this fact because of the New England Journal of Medicine's rules that authors disclose any conflicts of interest.
''I would hope it doesn't make people less willing to hear our message," Mongan said. He said that Partners hospitals ''in a way would be better off" financially if they didn't treat so many uninsured patients. ''But we do, and we should get credit for that," he said.
Dr. Jeffrey Drazen, editor in chief of the New England Journal of Medicine, said he included Mongan and Lee's article in the issue because ''they have an interesting perspective on the problem. We've heard a lot of people talking about how to save money on healthcare. They're saying maybe this is going to cost more money and we're going to have to face that. It's politically difficult but these guys are not politicians," he said.
Mongan and Lee briefly addressed costs, saying if they reached a certain level, it may be necessary to limit or ration services.
In an accompanying editorial, Richard Kronick, of the University of California at San Diego, said any plan for universal coverage also must reduce waste as ''many resources are used in clinical and administrative activities that do little to improve health."
In an interview, Stuart Altman, a health policy specialist at Brandeis University, said he long has advocated for employer mandates and wrote President Richard Nixon's failed healthcare plan in 1974, which included requirements that companies provide medical coverage to their workers. But, he said, ''it is fraught with political and economic peril. You run into a firestorm of attacks mainly from small businesses," he said. ''I'm not sure we're at a cycle where we're willing to look at that. While the number of uninsured has grown, it's not perceived by the middle class and the insured as a problem."
And that opposition from Massachusetts' business community still is strong. Employer mandates don't make sense because ''most of the businesses that don't provide health insurance are small and they don't provide it because they can't afford to," said Eileen McAnneny, vice president for government affairs for the Associated Industries of Massachusetts, an employers organization.
Liz Kowalczyk can be reached at email@example.com.