State health care effort cited as model for wider reforms

WASHINGTON—The drive that led to the passage of landmark universal health care coverage reform legislation last year could be a model for legislative efforts in other states and in Congress, a top Massachusetts hospital executive says.

Massachusetts legislators were successful because of a "common sense" approach in tackling the toughest issues, said Dr. James Mongan, president of Partners HealthCare System Inc. in Boston.

Speaking last week before the Senate Finance Committee, Dr. Mongan said Massachusetts leaders honestly faced up to the issue of how to finance an expansion of coverage.

The guiding philosophy, Dr. Mongan said, was "everybody pays something." To that end, the expansion of coverage is being financed by federal and state funds, provider taxes, contributions by employers that do not offer coverage and by premium contributions from individuals.

The path to success, Dr. Mongan said, consisted of an honest appraisal of the problem and a "philosophy of sharing and fairness regarding revenue," he told the Senate panel.

"I commend this formula to your attention as you begin your important work on universal health care coverage," he said.

Another panel witness, Stuart Altman, a longtime health care scholar and now a professor at Brandeis University in Waltham, Mass., advised the panel to build on the current financing system as much as possible.

To do otherwise, Mr. Altman said, generates a tidal wave of opposition from interest groups that might lose out. Because they have a lot to lose, "they form alliances with other 'loser' groups to derail such legislative initiatives," Mr. Altman said.

Indeed, Mr. Altman said it would be a "big mistake" for federal legislators to try to expand coverage and hold down costs simultaneously.

It is unlikely, he said, that combining the two initiatives would generate enough support to counter the "combined negative forces that will oppose the coverage and cost control legislation," he said.

Since it would be easier and more important to expand coverage, Mr. Altman advised the panel to start on the coverage issue first.

The lack of universal coverage in the United States hurts both the uninsured and employers providing coverage. Because they lack insurance, the uninsured often delay in receiving treatment, waiting until they are very ill and require catastrophic intervention, Mr. Altman said.

The care then is delivered in hospital emergency rooms, the most expensive place for treatment. Providers, when it is possible, then shift the cost of treating those without coverage to insured patients, inflating their bills and ultimately increasing group health insurance premiums and making that coverage less affordable, Mr. Altman said.