Wednesday, September 18, 2013

Exceptional? Please.

I never, ever thought I would be quoting Vladimir Putin.  He said it in another context, and he probably said it to be politically manipulative, but the quote is a good one: "It is extremely dangerous to encourage people to see themselves as exceptional, whatever the motivation."

Thus, John McDonough's recent blog post, "Massachusetts Exceptionalism--A Forum on Costs," is interesting.  After describing a forum held by the Greater Boston Interfaith Organization, he notes:

That's what makes Massachusetts different.  Our intelligent and compelling health care cost conversation continues.  And because groups like GBIO are staying involved and attentive, the issue is far less likely to wither away.  But it's not just a conversation -- it's a conversation with consequences.  And no other state right now is close to having this kind of conversation. 

That's worth noting and celebrating.

The existence of the conversation is, indeed, worth noting, but people in other parts of the country would be smiling and indeed laughing at Massachusetts' self-congratulatory view of its public debate.  Why?  Because the Massachusetts health care environment remains provincial, arrogant, and hidebound.  The "conversation" to date has permitted a dominant provider system and a dominant insurance company to extract billions of dollars of business and consumer money for no added value to the public.  It stubbornly refuses to demand from hospitals what is the norm in many other regions in terms of process improvement and the quality and safety and transparency of health outcomes.  It allows a private equity firm to purchase a major component of the health care system with no regard to the downstream impacts of the financial model used by that sector of the economy.  Finally, it stands by and watches the slow and perhaps irrevocable deterioration of the safety net system.

For sure, Massachusetts can be proud of leading the country on providing insurance to most citizens.  It can be proud of the research, teaching, and much of the clinical care that takes place here.  It can be especially proud of the men and women who work in the hospitals, community health centers, and other health care facilities.  But it has--and will--incur a heavy burden for being politically unable or unwilling to take on major drivers of health care costs in the state.


Anonymous said...

Or perhaps it is the very situation you describe which is causing MA to have that cost conversation earlier than other states......

nonlocal MD

Anonymous said...

please correct me if I am wrong, but I believe that places like Oregon and Utah, have high quality care, as high or higher than in Mass., but at much lower cost.

And I we used to be the most expensive in the country, and are still one of the most expensive states for health care.

The best high quality, low cost systems are said to be in places like Geisinger, Cleveland Clinic, Mayo Clinic, and again those in Utah, Oregan and other places far from Mass.

And even our "high quality low cost states" are much lower quality and high cost compared to most of the is shown in international comparisons Paul keeps publishing.

America's history has made us exceptional in many things: 1) when we dominated the world we spread democracy, human rights and prosperity 2) exceptional entrepreneurship, science and invention 3) we strive to treat all by the content of their character not the color of their skin, religion, sexual orientation and other forms of segmentation 4) the freedom to allow creativity to flourish ..... and much else.

but health care is not on the list.

Patty said...