Clipboard: Typical allies on health care not speaking with one voice on costs

By Chelsea Conaboy, Globe Staff

A few Globe health stories to chew on this morning:

Business and consumer groups that were close allies during debate over the 2006 state health law are divided over how far the state should go in its plan to control health costs, I reported in today’s Globe:

Associated Industries of Massachusetts, a business trade group, has called for tighter controls on spending than the House or Senate has proposed. Its regular allies - including the Massachusetts Taxpayers Foundation, a research organization for employers - warn against over-regulation.

The fracture highlights how the health care debate has changed in five years. There are no clearly defined camps. Controlling costs is a more nuanced issue than expanding coverage, some advocates said. And the stakes are higher.

“We’re talking about revenues in the health care system,’’ said Richard C. Lord, president of Associated Industries of Massachusetts, which represents about 6,000 businesses. “Every dollar in the system is somebody’s income stream. So, every dollar has an interest group that represents it.’’

Globe columnist Joanna Weiss mulls over the implications of a high-cost health plan, when a family of four meets their deductible. She concludes:

For the rest of 2012, the parents, if they wanted, could to go the emergency room every time they needed basic care. They won’t. But they’re considering their health care writ large, planning to get a few smallish, quasi-elective procedures they might have otherwise delayed. Why not? For the rest of the year, containing costs is someone else’s problem.

If you missed it, read this opinion piece from Ellen Zane, former chief executive of Tufts Medical Center. Zane warns about existing disparities in what hospitals and doctors are paid being “enshrined in perpetuity in a global payment system,” in which providers are given a budget for caring for patients rather than being paid for each procedure:

An inconvenient truth about Massachusetts health care system is the fact that the income profile of where you live is a better predictor of what insurers will pay for your health care than almost any other factor. This reality has not been changed by any of the payment reform experiments currently under way, nor by anything that has been recently proposed. So I remain deeply unsettled by wishful thinking that our market will solve our health care cost problem if left to its own devices.