Health or Consequences

[Originally published Sep 27, 2019]

KATE WALSH says she favors Medicaid for all, not Medicare for all.
It’s not a political slogan you hear much these days, but Walsh, the president and CEO of Boston Medical Center, has a unique perspective since so many of her hospital’s patients are on Medicaid.

“I actually think Medicaid is the most important insurance plan in the country,” she said, noting that it covers roughly 79 million mostly poor and elderly Americans and provides them with coverage for long-term care, medicine, behavioral health, and substance abuse. Every state offers Medicaid, so there is opportunity for local customization of insurance offerings.

“Why I’m a Medicaid for all person is it’s a public option that works for the public,” she said.” I think Medicare for all is a much better political slogan and I’m afraid it’s just that.”

On Health or Consequences with John McDonough of the T.H. Chan School of Public Health at Harvard University and Paul A. Hattis of Tufts University Medical School, Walsh said the issue that keeps her up at night is “the dissatisfaction most Americans have with our health care system.”

[Originally published Jul 14, 2019]

It isn't surprising that Amy Rosenthal, the executive director of Health Care for All, wants to rein in the cost of prescription drugs. She's been quite clear that breakthrough drugs don't have much of an impact if people can't afford them.

But her talk of shared responsibility on Health or Consequences with Paul Hattis and John McDonough took the debate in a new direction. She said she has made the rounds with all of the players in the Massachusetts health care system and discovered a shared pride in all that has been accomplished in terms of near-universal coverage and moderating prices. Each of the players has contributed.

"Individuals were required to start buying health insurance, the individual mandate," she said. "Employers had an employer assessment. Hospitals and insurers have to go before the Health Policy Commission. All of these things were not easy. People had to put some serious skin in the game. And all we're saying at this point is that it's time for pharma to do their part in this."

[Originally published Jun 9, 2019]

The Center for Health Information and Analysis produces reams of data for both Massachusetts policymakers and the public, providing a window into state health care expenditures and offering tools to compare prices between different providers.

Ray Campbell, the executive director of CHIA, walked through some of the available online data tools during a recent conversation with Paul Hattis and John McDonough for their “Health or Consequences” Codcast.

“No other state has an organization quite like CHIA,” said Campbell, who added that the agency, which is funded by assessments on the health care industry, looks into spending on hospitals, drugs, and doctors, and it gains some important insights from the all-payer-claims database.

While CHIA has access to tools that are unavailable in other parts of the country, the agency can’t see everything, so it works collaboratively with the health insurers to give consumers a more complete idea of what they might pay for a particular procedure.

[Originally published May 6, 2019]

The co-chairs of the Legislature’s Joint Committee on Health Care Financing may be new to their posts, but both seem to grasp the urgency of tackling big issues facing the state’s health care sector and both sound optimistic about solutions to some thorny problems emerging in the current session on Beacon Hill.

That’s the takeaway from a conversation with Sen. Cindy Friedman and Rep. Jennifer Benson convened by Paul Hattis and John McDonough as part of their “Health or Consequences” interviews on The Codcast.

One of the biggest issues looming over the health care sector: the large price variation in what hospitals charge for similar services, a problem that vexed lawmakers last session, as they adjourned without reaching agreement on an approach to dealing with it.

[Originally published Mar 24, 2019]

The chief executive of Harvard Pilgrim Health Care doesn’t want the government to take over the entire health insurance business – at least until after he retires – but he sees some advantages to the movement seeking an expansion of Medicare so that government-backed insurance covers everyone.

For one, Harvard Pilgrim CEO Michael Carson thinks Medicare for All – a rallying cry among many Democrats – is part of an important discussion to have. For another, Carson said, the best plan is a middle way that involves more collaboration between the government and private insurers.

Carson shared his thoughts about potential changes big and small to the health care marketplace with Paul Hattis, an associate professor at the Tufts University Medical School, and John McDonough of the Harvard Chan School of Public Health, during the “Health or Consequences” Codcast.

[Originally published Feb 15, 2019]

When it comes to the state of our health, there is a glaring disconnect in the US, says Sandro Galea. We spend far more on health care per capita than any country, yet we’re far less healthy than those in many other developed countries as measured by all sorts of indicators, including life expectancy.

Our cutting-edge new medical treatments and drugs are wonderful, says the dean of the Boston University School of Public Health. But he says we are focusing on them to the exclusion of all sorts of factors in everyday life that have a profound effect on health. Galea joined John McDonough and Paul Hattis for the latest installment of “Health or Consequences” on the Codcast, where he unspooled his take on how we’re missing the boat when it comes to promoting good health.

A native of Malta who trained as in emergency medicine in Canada, Galea described his migration from work as an acute care doctor to the field of public health. When treating patients on the frontlines of medicine, “you are sharply aware of what really shapes health,” he said. “What drives health is not so much the immediate experience, but a lifetime of experiences in the world around people and the context in which people live.”

[Originally published Jan 19, 2019]

Andrew Dreyfus, the CEO of Blue Cross Blue Shield of Massachusetts, is excited about a series of initiatives the state’s largest health insurer is pursuing to improve care while simultaneously treating patients in less costly settings.

One initiative, a pilot project with South Shore Hospital, rewards the facility if it succeeds in admitting fewer patients and doing fewer procedures. Dreyfus, appearing on the “Health or Consequences” Codcast with Paul Hattis, an associate professor at the Tufts University Medical School (co-host John McDonough of the Harvard Chan School of Public Health was on jury duty), said the goal of the pilot project is to reverse the incentives that currently reward hospitals for seeing more patients and doing more procedures.

What’s it like to be in charge of nearly half the state budget?

Extraordinarily humbling,” said Marylou Sudders. But don’t confuse humbling with cautious indecision or lack of tenacity.

Gov. Charlie Baker’s health and human services secretary has a reputation for strong leadership and a social worker’s commitment to the enormous range of state programs she oversees, led by the Medicaid program that delivers health care coverage to 1.8 million state residents. Sudders said she is on board for a second Baker term, and highlighted some of the priorities she’ll focus on, including another stab at reining in Medicaid drug costs, an initiative to preserve access to community hospitals, and continued work to ensure access to mental health services.

Sudders said the state has built up a lot of protections against any rollback of the Affordable Care Act, but called herself a “worrier” who nonetheless closely tracks developments outside the state -- prescient words on Friday afternoon, only hours before a federal judge in Texas struck down the entire federal law.

Sudders touched on those topics and more in the inaugural episode of “Health or Consequences,” a new health policy-focused entry to the Codcast line-up being helmed by John McDonough, a one-time Massachusetts legislator who now teaches at the Harvard Chan School of Public Health, and Paul Hattis of Tufts University’s School of Medicine."

[Originally published Dec 16, 2018]