Massachusetts’ socialized health care system moves to ration care

Victor Joecks

In 2006, Massachusetts passed many of the socialism-lite health care changes now being considered by Congress – including an individual mandate, new government subsidizes and an expansion of Medicaid.

And following right in the footsteps of socialized medicine in Canada and the UK, health care officials in Massachusetts are now proposing limits to health care to control rapidly escalating costs (also known as rationing).

The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers.

But a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care – an issue some providers say the commission and the Patrick administration have glossed over.

“You can’t reap these savings without limiting patients’ choices in some way,” said Paul Levy, chief executive of Beth Israel Deaconess Medical Center. “It’s a huge issue, it’s huge.” Dr. James Mongan, president of Partners HealthCare, a Beth Israel Deaconess competitor, agreed that it wouldn’t “work without some restriction on choice.”

And that’s not the worst of it. They also want to give doctors a financial incentive to not – I repeat, not – treat patients.

What the supporters don’t mention is that it also creates a tremendous incentive for physicians and hospitals to render as little care as possible. Under the Massachusetts proposal, if your care costs less than the annual allotment, then they keep the unused portion. If your care costs more, then the difference comes out of the providers’ pockets. Such a system thus pits your doctor’s interests against your own.

For the sake of argument, suppose your annual allotment is $5000 and you’ve already spent $4500 for that year. Now you go to your doctor’s office complaining of a severe headache. He examines you and says, “No, Bill, you don’t need a $1000 MRI scan of your brain. Just take two Tylenol and call me in the morning”.

Will you be 100% sure that he’s giving you unbiased medical advice?

And even if your doctor consistently and conscientiously acts for his patients’ best interests, he will inevitably find himself at odds with hospital administrators questioning whether this or that expenditure is appropriate[.]

Socialized medicine is a lose/lose: higher costs and less care.

Update: Tweaked the title