Not so simple

Not so simpleA story in today's Boston Globe (Care bill may be a hospital bonanza) contends that health care legislation in Massachusetts, framed under the guise of improving coverage for underserved patients, has turned out to have somewhat different beneficiaries than expected.

With heavy lobbying from powerful healthcare providers and insurers, a bill designed to expand healthcare coverage to the uninsured has turned into what many critics say is a financial bonanza for some of Boston's major hospitals...''Powerful hospitals and insurers did a better lobbying job than access advocates," said Alan Sager, one of two directors of the Health Reform Program at Boston University's School of Public Health...

It's tempting to swallow the Globe's logic and blame lobbyists for a bad outcome, but the main problem is that any legislation that injects more money into the payment system will naturally tend to benefit strong providers and payers who are already supplying or subsidizing services to those who are uninsured or underinsured.I'd rather see money spent on re-engineering and restructuring care delivery and empowering patients with information. Simply adding dollars to the existing reimbursement scheme will have the predictable effects outlined by the Globe.