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The State Senate Shows Its Hand -- Game On

Posted by John McDonough  May 10, 2012 10:50 PM

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We now have initial legislative proposals from both the House of Representatives and the Senate to create new mechanisms to control the rising growth of health care costs. After reading both of them, I agree with MIT economist Jon Gruber who notes that the similarities vastly outweigh the differences. Even though the co-chairs of the Joint Financing Committee, Senator Dick Moore (D-Uxbridge) and Representative Steve Walsh (D-Lynn) were unable to agree on a common proposal in committee, their two versions are mighty close.

And that's not a bad thing at all if you would like to see something happen in the short amount of time that remains between now and the end of the legislative session on July 31st.

Both bills propose aggregate annual limits on the growth of health system costs. The House version is the tougher of the two, aiming to get spending increases that are 0.5 percent less than the growth of the state economy, while the Senate version targets spending increases to grow no greater than state economic growth or as much as one percent higher.

Both bills leave the particular enforcement mechanism unspecified if spending increases violate those limits. "We view this as a step in the right direction but not necessarily the end solution," Moore told Sarah Kliff of the Washington Post.

Both push health care providers to move away from fee for service and toward accountable care organizations. Electronic health records would be required for everyone. Administrative simplification. Health care workforce improvements.

Both bills set up a new Trust fund to advance prevention, wellness, and public health, though the Senate guarantees $100 million in real funding over five years while the House bill leaves the Fund, well, unfunded.

Both address medical liability reform through protecting provider apologies from lawsuit exposure; both establish new tools to educate consumers; both encourage employers to promote wellness among their workers.

So what to think?

First, like it or not, a heavy hammer regulatory approach is not in the cards, not this year.

Second, both bills propose "soft accountability" that will compel public discussion if costs begin to shoot up again in a few years. That is no guarantee at all, and yet it is also significantly better than what occurred in the past decade when there was no mechanism to force the conversation when costs started growing out of control.

Third, it's good that both bills pay attention to prevention and public health, and it's a lot better that the Senate bill proposes paying for it.

Fourth, given the lack of compelling differences between the two proposals, it is going to be difficult for the public to notice or to pay much attention or to get very excited.

Finally, there is a lot of good work that has been done by the key legislators on both side, particularly Sen. Moore and Rep. Walsh, and they deserve credit for moving this complex issue forward.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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