| Almost without exception, policy makers find 1+1=2 an easier proposition to understand than 2-1=1. Just consider the ease with which earmarks are ‘sold’ in the political marketplace and the difficulty of trying to stay focused on providing high-quality core services.
The politics of addition seem to be absorbed through the palms of politicians’ hands during their swearing-in ceremonies. Democrats have their share of egregious examples, most notoriously the Clinton health care reform effort, with its cast of hundreds of policy makers and thousands of pages. But congressional Republicans have proven this is not a matter of party affiliation.
Here at home, there was the less memorable Romney climate change plan, with its litany of 73 ‘action items.’ When people trumpet action items (and worse, the gross misuse of the English-language ‘actionable items’), be prepared to be less than impressed with the results. They will collapse under their own weight and land in the inactive file.
Gov. Deval Patrick’s readiness project is the latest in this line of policy-making, crafted by a cast of hundreds, with 24 action items, numerous other recommendations, and, ahem, no way to pay for any of it. Moreover, it was beyond even the governor’s noteworthy oratorical ability to summarize it. He was wise to take three days to roll it out because, well, it took all of that.
There are complex pieces of legislation that start with an idea and are not premised on the politics of addition. The Education Reform Act of 1993 was conceptually simple: more money in exchange for high standards, accountability, and innovation.
The same was true for the Healthcare Reform Act of 2006. However complex, its basic proposition was unambiguous: shift subsidies away from institutions and toward health care consumers. That elegant formula was interesting enough to get left and right, federal, and state leaders on board.
We are already well into the new fiscal year, and negotiations with the federal government continue over whether it will renew the waiver that facilitated the Commonwealth’s health care experiment in the first place. It might be useful to remember that no matter how conceptually interesting, even idea-based reforms face the logic of mathematics. They have to be affordable.
The Education Reform Act of 1993 required the grit of legislators and the governor to make good on the promised massive funding increase needed to make it viable. And now we must remain faithful to the idea of the Healthcare Reform Act, or the federal government will kill it.
The government wants reform, and it doesn’t want it to affect federal coffers. Reform is happening; we have successfully signed up hundreds of thousands who were previously uninsured. One has to assume that the reduction in the number of people showing up to emergency rooms without insurance is translating into less of a burden on hospitals, especially those that previously provided care to a disproportionate share of the uninsured — specifically Boston Medical Center and Cambridge Health Alliance.
To remain cost-neutral to the federal government, we have to address this year’s shortfall of $153 million and a minimum shortfall of $184 million next year. In the long term, there are several things we can do to contain health care costs, including perhaps a hard look at certain benefits mandated in the law and increasing the transparency of cost and quality data useful to consumers.
But there is really only one way to address the costs of the legislation in the immediate term: reduce the level of extra payments to Boston Medical Center and Cambridge Health Alliance, which were granted special annual payments that began at $200 million and ratchet down by $20 million a year. These special institutional payments were meant to ease the hospitals into the new regime. They were also very much a political deal.
However important Boston Medical Center and Cambridge Health Alliance are, they must play by the same rules as other hospitals and must not put the entire reform at risk. It is no doubt true that hospitals like Baystate Medical Center in Springfield, among others, face the same challenges. And there is a larger reason: the whole point of the health care reform was to focus on people. So let’s do that.
Jim Stergios is executive director of Pioneer Institute. |
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