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Bay State health insurance premiums highest in country
Massachusetts has the most expensive family health insurance premiums in the country, according to a new analysis that highlights the state’s challenge in trying to rein in medical costs after passage of a landmark 2006 law that mandated coverage for nearly everyone.

The report by the Commonwealth Fund, a nonprofit health care foundation, showed that the average family premium for plans offered by employers in Massachusetts was $13,788 in 2008, 40 percent higher than in 2003. Over the same period, premiums nationwide rose an average of 33 percent....

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Pay for care a new way, state is urged
A state commission recommended yesterday that Massachusetts dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control exploding healthcare costs and improve the quality of care.

The 10-member commission, which includes key legislators and members of Governor Deval Patrick’s administration, voted unanimously to largely scrap the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit. That arrangement is widely seen as leading to unneeded tests and procedures.

Instead, the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person’s care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients’ care, which could improve quality and reduce costs....

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Controlling Health Care Spending in Massachusetts
In 2006, Massachusetts passed landmark legislation ensuring near-universal health insurance coverage to residents of the state through a combination of mechanisms. By 2008, only 2.6 percent of Massachusetts residents were uninsured, considerably below the national average of 15 percent.

However, continued increases in the cost of health care services threaten the long-term viability of the initiative. As highlighted in Figure 1, in the absence of policy change, health care spending in Massachusetts is projected to nearly double to $123 billion in 2020, increasing 8 percent faster than the state's gross domestic product (GDP).

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Defending the Massachusetts Health Care Reforms (Or Not)
... * Both liberals and conservatives agree that "Massachusetts hasn’t figured out a way to restrain the overall growth in health care costs. If national health care reform fares no better, the country could be in serious fiscal trouble."
* The system is not the single payer plan some liberals might prefer, but nevertheless constitutes "a large expansion of government, even by Massachusetts standards."
* Under the current system, "by law, anybody living in Massachusetts must obtain health insurance or face a penalty, which this year will be as much as $1,068."
* As it currently stands, "Massachusetts has the nation’s highest premiums, at more than $13,000 a year for the average family policy."
* Insurance coverage in the state is now the highest in the nation, but "coverage by itself is meaningless if it doesn’t translate into more access to medical care or less financial hardship because of medical bills. And there is evidence, mostly anecdotal, that some people are really struggling under the new scheme, either because it’s tough to pay the insurance premiums or because, even with coverage, their medical bills are a burden."
* "Massachusetts reforms haven’t brought down prices on the whole. In fact, premiums for people who get insurance through employers are rising a tad faster than they are in the country at large. If costs continue to skyrocket, the state’s health care reforms will become unsustainable, requiring either large cuts or tax increases."
* When Massachusetts, which the article calls "the ObamaCare laboratory," enacted its reforms, "the goal was simply to expand coverage and, perhaps, deal with costs later."
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