Boston Globe: Serious Rationing Nearly a Reality Under MA's CommonwealthCare

By Tom Blumer | October 12, 2009 | 23:26

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I suppose President Obama is still running around telling everyone who will listen, along with anyone else who won't, that "If you like your doctors and medical providers, you can keep them."

It would also not surprise me to learn that Massachusetts Governor Deval Patrick is still singing the praises of CommonwealthCare, the state-run system conservatives also deride as RomneyCare, so named after Mitt Romney, Patrick's allegedly Republican predecessor who brought it into being. Patrick even wrote a Wall Street Journal op-ed column several weeks ago that called CommonwealthCare a "model for national reform."

As an apparently pivotal Senate committee vote on imposing statist health care on the entire country looms, the Boston Globe's Liz Kowalczyk has inconveniently reminded statists (HT Hot Air) that the alleged wonders of the Bay State's care regimen are instead leading it inexorably into serious rationing, and to a direct contradiction of Obama's and Patrick's core claims. Currently on the horizon are serious limitations on choice of care providers and annual capitated payments to those providers. Kowalczyk would probably protest that she never uses the word "rationing," but it really doesn't matter. Anyone with even a modicum of sense will recognize these moves for what they are.

Here are some of the key paragraphs in Kowalczyk's Sunday report:

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.

.... a growing number of hospital officials and physician lead ers 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."

A state commission recommended in July that insurers largely scrap the current fee-for-service system - in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit - and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.

.... The Massachusetts proposal would involve a more ambitious restructuring of health care than any of the cost-cutting ideas being discussed in Washington. Under a global payment system, doctors, hospitals, nursing homes, and other providers would form large networks, called accountable care organizations, that would provide most of the care for individual patients and divvy up the payments. Doctors would try to coordinate patients’ care within these networks, which would share electronic medical records and treatment plans. And to manage costs, they would try to direct patients to the hospital within the network that could provide good-quality care at the lowest cost, while generally using teaching hospitals for advanced care.

.... Sarah Iselin, head of the state Division of Health Care Finance and Policy and cochair of the payment commission, said the (commission) panel understood the importance of addressing the effect of its recommendations on patient choice, but “felt these issues could be figured out" later by a board that would be created to oversee the transition to a new payment system.

Well, if CommonwealthCare is indeed the model, then its imminent rationing should also be seen as a preview of things to come nationwide, regardless of the pie-in-the-sky contraptions Congress is attempting to cobble together. When theses messes meet reality, they invariably lead to rationing accompanied by a shocking degree of bureaucratic control over the minutiae of medicine.

Ed Morrissey at Hot Air adds this question: