THE NOT-QUITE secret of healthcare in Massachusetts is that, though it is usually high-quality, it costs too much. To get a dialogue going about how costs can be restrained, Senate President Therese Murray proposes to force health insurers to explain why they need to raise prices.
The state now lacks any coordinated response to premium increases, which are expected to be about 10 percent next year. Most people value health insurance, and they or their companies find the money to pay for it. But fewer younger, healthier people are joining the state's workforce to defray the costs incurred by the older, sicker population. Eventually, insurance will cost so much that it will price people out of comprehensive coverage, unless steps are taken to moderate the increases.
The issue attains greater urgency because of the 2006 passage of the Health Reform Law, which mandates that everyone in Massachusetts be covered by insurance unless they can show that it would constitute an unsupportable financial burden. This means that people of modest incomes are expected to buy insurance, even if their employers do not cover any of the cost. It's unfair to force them to buy coverage and then do nothing as costs escalate at double-digit rates.
Murray's idea, unveiled before the Greater Boston Chamber of Commerce last week, would apply to annual increases above 7 percent. The insurance commissioner would be required to hold hearings and at least investigate the causes. Senator Richard Moore is drafting a bill based on her ideas.
Hearings by themselves are hardly the antidote to higher costs. But they will get the attention of insurance regulators, who have been preoccupied by auto rates for the past couple of years. And the hearings would force the insurance companies to explain how much they pay in overhead and how much is distributed to physicians, hospitals, and other health providers. The providers in turn would have to defend increases in their charges.
One reason costs are so high in Massachusetts is that many people are accustomed to visiting specialists rather than primary care doctors, who are in short supply. Murray proposes to offer loan forgiveness to primary care doctors and to provide greater opportunities for nurse practitioners to take their place where appropriate. To control costs, the state needs to adjust the balance between specialists and generalists.
An aging population and improvements in medical technology are among the reasons health costs are soaring. Some increases are inevitable, but society should be looking for ways to reorganize the system so that care could be more efficient without reducing quality. Before attempting changes, the state needs to know exactly who is benefiting from health insurance premiums now.
