Opinion The State Needs Strategic Thinking On Health Care

Massachusetts faces a health care crisis of unprecedented proportions. The number of uninsured people continues to grow, the costs of providing health care continue to skyrocket, and many of our medical institutions have faced years of staggering financial losses. Now we are confronted with a state budget crisis whose magnitude threatens to further destabilize the health care system.


As a Massachusetts resident and physician, I anguish over the toll this will take on the state’s most disadvantaged citizens. As CEO of one of the nation’s largest children’s hospitals, which has faced its own financial struggles in recent years, I understand that difficult choices must be made by the new governor.

The challenge faced by Gov. Mitt Romney is to reconcile the short-term need to balance state revenues and expenditures with the long-term goals of enhancing state access to health care and stabilizing the state’s health care infrastructure.

Romney has proposed a framework for managing health care, including consolidation of human service functions, case management for clients served by multiple agencies, and maximizing federal reimbursement for core health functions. One way to realize the greater efficiencies envisioned would be to enhance access to primary care within the state. Not only is this goal a matter of compassion and dignity; it also makes fiscal sense, promoting better management and coordination of patient services to avoid unnecessary, expensive trips to already overcrowded emergency rooms.

The recent state decision to eliminate benefits for 50,000 citizens covered under MassHealth Basic does not reflect the governor’s framework, and restoring funding for this program should be a priority. Many people covered by this program are homeless and/or mentally ill, with multiple medical issues requiring the services of a number of state agencies. MassHealth Basic was a first step in providing greater coordination of benefits to this population. By eliminating these benefits, we are trading cost-effective primary care for more expensive services down the road.

As a result of our prolonged economic malaise, and with the number of people without health insurance continuing to climb (an estimated 397,000 in Massachusetts), there is growing pressure on the state’s health care safety net, especially the free care pool. There are steps the state can take to relieve the pressure on hospitals and community health centers that provide this care. As a matter of sound public policy, we need to find equitable mechanisms for funding the cost of care for low-income and uninsured individuals in the Commonwealth. Caring for the most vulnerable citizens in our state is a societal obligation to which all economic sectors must contribute. Continuing to place the burden of funding shortfalls in the free care pool almost entirely on the backs of hospitals and community health centers threatens the stability of these institutions, potentially contributing to another round of closings.

Finally, the governor should consider that health care is one of the key drivers of the Massachusetts economy. This sector is the single largest employer, accounting for 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all jobs in the state. This sector also attracts more federal medical research funding — $1.6 billion — than any state in the nation. The money has an enormous multiplier effect: it results in an additional $1 billion a year for the Massachusetts economy.

As we approach budget issues, we need to think of health care from an economic development perspective. Romney should push hard for federal restoration of Medicare and Medicaid funds cut by the Balanced Budget Act, including funding for medical training programs. He should position this state as the leading supplier of intellectual capital on the complicated research and public health issues affecting our nation. Private dollars follow public investments, so we will be doubly served by marketing our strengths. These investments will return to state government many times over in increased tax revenues, lower unemployment, and a vibrant economic base.

We will live with the consequences of the choices we make in these difficult fiscal times for years and perhaps decades to come. Romney has spoken forcefully of the need to invest in our people. Certainly one of the most important investments we can make is in the health of our citizens. Making such an investment requires that we adopt a strategic perspective that does not sacrifice the long-term welfare of the community for short-term gains. It will be a challenge, but compassion, sound health care management, fairness, and economic investment and growth demand it.

Dr. James Mandell is president and CEO of Children’s Hospital in Boston.

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