actually scot, a direct question or questions deserving or demanding an answer from you and a few of your colleagues to people that you have access to like the governor or mayor would TEST THEIR SKILLS. BIG TIME but sadly, i guess thats not in your job description. now or ever. btw, where is mr. patrick well regarded except in the minds of the people who are to scared and adverse to getting at the truth and prefer to stay on his good side by printing pablum time after time. ma

The attempt to place price controls on medicine, the result many of us have predicted for years, will lead to shortages. You can bank on it. While Obamacare, and Romneycare thought they could operate outside of the laws of economics, the rise in costs in Massachusetts prove how much of a fantasy that is. Think about it for one minute: If you are paying, $300 per month for your share of the insurance premium, the insurance company has built into that premium a list of benefits and coverages, as well as a modest profit. If the government comes in, and says: You must now cover anyone, regardless of pre existing conditions; kids can stay on their parents plan to age 26, women are entitled to free birth control.........All these mandates, and you think your premium could possibly stay at $300 per month? Price controls will lead to insurers and providers to get out of Dodge, rather than lose money.

The problem of health care cost festers because its root causes are not addressed. Hospitalists, palliative care, patient centered home care, EMRs, and reduced admissions add to the bottom line not subtract. All of these services increase payroll. Efficiency only comes by reducing personel in the system. This is where some study of what can done be must be reviewed. The reality is if the same number of doctors, nurses, and auxiliary staff remain the budget is unchanged and if they deserve raises or more are engaged the outlay increases. It is not feasible or reasonable to decrease these professionals since care will suffer. Nurses are already up in arms because of poor nurse-patient ratios or floating to areas where their training is a bit rusty. Who wants to be taken care of by an overworked professional who is responsible for your life? What's left? Because of our payment system with complex negotiations and uneven pricing, non profits acting like profits with unseemly salaries, and cherry picked risk pools instead of more universal ones we are draining $400 billion a year from the system. These administration workers and officers at all levels of the system need to be pared down by paying attention to what was just outlined. However it should not occur in a Romneyesque fashion. These highly skilled people must be transitioned to other places of employment by careful matching of skills or retraining. Insurance companies, for example, have doctors,nurses, expert managers and number crunchers in their midst to oversee onerous company policies. Some of the money to do this will come the process of reduction itself by freeing up more employers to hire because their health insurance premiums dropped considerably. For any organization the salary one must pay in the form of health insurance represents cost number one. Eliminating redundant or unnecessary care is a needed laudable goal but it does not change the bottom line. It shifts it where it should be more properly used. Streamlined universal coverage of necessary care is a boon to capitalism not the opposite.

Are you suggesting that the present system with greater than inflation or cost of living increases is the way to go. As for non coverage or under-insurance this leads to 45,000 excess deaths a year. Because of the Republican economic recession people are foregoing care and have added to this. Employers should not be the deciders what proper coverage means. I'm not suggesting they just grin and bear it but some method, like other advanced societies, have solutions that provide the care without busting the bank. Before you draw out the usual horror stories that exist for any system, you should know we lead the pack in that category.

Yawn

"Nurses are already up in arms because of poor nurse-patient ratios or floating to areas where their training is a bit rusty." It is a bigger issue than "rusty skills". Sending someone to work in a area where your last experience was a few weeks rotation 10 years ago in school is dangerous for the patients on that units. Before our last flirtation with capitation in the 90s you could assign the nurse who floated to the unit the easy patients. There are no easy patients anymore. Throwing patients out out sicker and quicker has been the rule for over 20 years.

OETKB brings up an important point. A study published in the NEJM in Oct 2011 looked at health care employment in MA since RomneyCare. Despite the increased demand the number of direct patient care providers (doctors, nurses etc) rose slightly. However the number of administrative employees (billing, pre-authorization staff etc) rose by 28%. The insurance industry loves its bureaucracy and micromanaging the way providers practice. Of course this is not free and the cost is passed on to consumers. In addition the push to so called "quality" has also increased administrative costs. Hospitals are devoting staff to make sure that the correct data is collected on the few indicators that supposedly define quality. The biggest example of this is bringing in consultants to make sure staff use certain words to meet one of CMS's idiotic initiatives. For our legislature to address issue like this they would have to actualy know something about patient care. But they instead they turn to people like Ron Mariano (D-Cerberus) who doesn't have a clue and has now climbed into bed with the insurance industry.

These proposals and Obamcare will put private practice out of business. First resident doctors, then system-employed staff doctors and groups will unionize as they are asked to provide more "quality (i.e. cheap)" care for less reimbursement. It will be the only way to push back. One of the posters here today speaking to alleged nursing "shortages", has bought into the Nurses' Union mantra for increasing influence and union members numbers. Nurse anesthetists can make well over $200,000. The day is already here when a nurse declines to help out outside her job description in the OR, so imagine when the doctor says "the union won't let me" also. Grim prospect, but the scenerio I've depicted is plausible not too far in the future.

Richmond: You and I are pretty much in accord on that. I do most of the Globe's health-care editorials and we have cautioned about the very problem you cite when it comes to price controls/rate regulation. The right solution, I think, is products that let consumers/patients know the costs and share in savings when they choose less expensive care. Plus a move away from fee-for-service. That said, despite what one hears in, say, the WSJ, our law has worked quite well here. Relative to other states, our costs have gone frm #1 a few years ago to 8th or 9th now. And when it comes to ObamaCare, it's important to keep this in mind: You really can't prohibit the denial of care based on pre-existing condition unless you first require everyone to have care. Otherwise, people would just wait until they get sick or come down with a chronic condition and purchase their insurance at that point. Then it wouldn't be insurance, since insurance works on the notion that risks/costs of illness are spread across a pool of people who aren't all ill or sick. Mike: We regularly ask questions of officeholders. What is the burning query you so want asked?

So far we've seen comments regarding price controls (very much on topic, btw), insurance companies top-heavy with administrators, and a rant against unions. As individual issues, each of these is a problem, but all contribute to runaway expenses. Unfortunately, man is a political animal, and as these comments illustrate, while everyone has their favorite boogeyman, they will ignore the others. This is also why the entire political process has broken down; everyone is focused on pet issues and sniping about them and only considering pet solutions rather than looking at the whole.

Scot, I am glad you are able to this in the correct light. I will add to what I said before, that I believe the massive spikes in healtrh care costs are a direct result of government intervention in health care sonce the 1960s. With the introduction on Medicare and Medicaid, the government has poured trillions of dollars into the health care marketplace. When that happens, prices rise. The only way to reverse this, is to bring in marlet competition. This was done successfully with the Medicare prescription drug plan worked this way, and has come in under budget as a result of it. NEW PARAGRAPH: The issue of having a mandate to cover preexisiting conditions is difficult. There are many, in Mass, who forgo coverage and pay the fine, which is cheaper than insurance. They can always get insurance when they get sick. I think the key to cost control is finding ways to introduce competetition, and if both sides can make that their goal, they can work together to make it happen.

Having had the pleasure of working with some of our fine state employees, I can predict that having them intervening directly in the health care sector would be an unmitigated disaster. They are not bright enough, flexible enough, or inventive enough to work in that fast-moving climate. One can argue that Gottlieb is only looking out for Partners, but he is a wise man who does not want to see our preeminence in healthcare undermined by the government's good intentions. I am with him. The thought of the state trying to somehow oversee health care delivery is freaking scary.

For those interested in learning more on this subject, I recommend the writings of Paul Levy, former CEO of Beth Israel hospital, and his blog at "RunningAHospital." Paul is a big proponent of bringing quality-based processes and tools into healthcare, and, as a former competitor, has a shrewd understanding of our local behemoth, Partners Healthcare, and the historic kowtowing ways of our MA-based insurance providers to this provider. This situation needs significant pressure to be applied to clean it up. For this reason, I personally support price controls as a way of continuing to send a clearcut message to our providers that "business as usual" is no longer acceptable. If nothing else, it will bring them to the table with an intent of trying new things, and innovative reform. For those that may not be aware, there are other national healthcare models that exist, particularly in Switzerland and Germany, that we could emulate, and that offer a combination of private and public service offerings in healthcare - and significantly better ROI than we're getting! To continue doing things the same way we've been doing them here in the US is insanity.

Not a fan of price caps and I think their is plenty of empirical data to show that it is a risky approach (utilities. It really focuses on controlling costs, which will lead to cuts in services. A concern with Ocare is the new taxes on medical equipment manufacturers which will need to be passed on. How can the hospitals plan for this on the L side of their P&L? An interesting approach is rate of return regulation. http://en.wikipedia.org/wiki/Price-cap_regulation

Richmond: On the prescription drug prices: I had originally thought the same and explored an editorial saying that. Here's the problem, however: If you look at what they call the dual eligibles -- folks who could get their drugs either through a private plan or through (usually) the VA plan that uses government buying power to leverage better prices, the folks who go the VA route pay less. That said, Part D has cost less than originally projected, which is a good thing. Does it cost less than it would if the program worked like the VA? Probably not. On another front, a friend posted a fascinating take by a credentialed Reagan conservative on today's GOP that sheds some light on the debate we had on Wednesday. It's worth a read. Here's a link: Peter Kadzis: When a professional centrist like Ornstein sounds the alarm about right-wing extremism, we should all take note. Along similar lines, here is a piece from today's Salon written by a professional conservative explaining why he's done with the right wing. http://www.salon.com/2012/05/24/my_break_with_the_extreme_right/singleton/

In Internet slang, a troll is someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking readers into an emotional response or of otherwise disrupting normal on-topic discussion.

In Internet slang, a troll is someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking readers into an emotional response or of otherwise disrupting normal on-topic discussion.

In Internet slang, a troll is someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking readers into an emotional response or of otherwise disrupting normal on-topic discussion.

Scot, Google what is going on with Brett Kimberlin. Interesting MA connection: Our esteemed Sr. Senator's wife's foundation donated to his cause.

Scot, thanks you for the link to that piece. I think the usual laundy list of right wing tales of dishonor gives this guy a place in Salon.com to be published. But it is not new, and it is NOT unique to the right wing. I would love to see a committed lefty write the same piece, covering all the examples of left wing rudeness and extremism. Books could be filled with the ugly tales. NEW PARAGRAPH: I have a link for you: Thomas Sowell recites Andrew Mellon on the relationship between tax rates and tax revenues. You seem to equate higher rates with higher revenues, and this will explain why it is not that simple. http://townhall.com/columnists/thomassowell/2012/05/23/a_book_for_republicans

Richmond: I agree it is not unique -- little is in politics -- but I do it is disproportionately a problem on the right. In that way, it's like filibuster abuse. The Democrats certainly have done that as well when they were in the minority -- but they didn't take anywhere near the extent that the Republicans have under Mitch McConnell, where virtually everything needs 60 votes. Why, for example, should dueling approaches to interest on student loans be filibustered? Just vote on the damn thing and let one approach or the other win. It's just not important enough to invoke a filibuster, which used to be reserved for things that were pivotal. I will take a look at that link over the weekend; for now, I have to write a health care editorial. Scot

National Security: New documents obtained by a watchdog group show our commander in chief gave the name of a Navy Seal Team 6 commander to the makers of a movie about Osama bin Laden. Valerie Plame, call your office.

Without his assent? That strikes me as unlikely, but please post the link.

http://images.politico.com/global/2012/05/judicialwatchbinladenmoviedod.html http://www.politico.com/blogs/under-the-radar/2012/05/pentagon-cia-white-house-opened-up-to-hollywood-on-124293.html

from the link: "The redaction suggests the disclosure of the Seal Team Six leader's name to Bigelow and Boal was improper," Judicial Watch president Tom Fitton told POLITICO Tuesday night.