Boston Globe Editorial IDIOTS! Re: Massachusetts Healthcare Reform

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Massachusetts Mandated Healthcare INSURANCE!
www.jonathanmelleonpolitics.blogspot.com/2008/10/massachusetts-mandated-healthcare.html
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2/11/2008

Dear Boston Globe Editorial Idiots!,

In response to your myopic piece entitled, "The health law is working", below: I must inquire, "For Whom Is It Working For?"

To answer my own question, the answer is that the new health care laws in Massachusetts are working AGAINST the common taxpayer, but for the CORPORATE ELITE's Interests!

You, "Boston Globe Editorial Idiots!", note that Governor Deval Patrick is budgeting $869 million for Commonwealth Care in his FY2009 state budget proposal with approximately 1/2 the cost borne by the federal government, which has a projected record level $400 Billion FY2009 budget deficit of its own with record level cuts to domestic programs including healthcare insurance for the diminishing middle class. Moreover, the projected FY2009 Massachusetts Budget Deficit is recurringly over the $1 Billion mark!

That all means that Governor Deval Patrick is O.K. with BORROWING taxpayer $ from future generation to redistribute to a select few Massachusetts Insurance Companies administering healthcare insurance policies to the uninsured.

This is who benefits from the new Massachusetts healthcare insurance law:

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5 Massachusetts insurers control about 90 percent of the healthcare insurance market in the Commonwealth of Massachusetts:
#1 - Blue Cross Blue Shield
#2 - Harvard Pilgrim Health Care
#3 - Fallon Community Health Plan
#4 - Health New England
#5 - Tufts Health Plan
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There are also national healthcare insurance companies such as United HealthCare Insurance Co., Aetna, and CIGNA.
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Source: "200,000 may need to get more insurance: State healthcare law sets higher minimums" (By Alice Dembner, [The Boston]Globe Staff, January 30, 2007).
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The state's plan relies largely on two sources: federal funds that are committed only through June 30, 2008, and the state's free-care pool, now used to pay for charity care at hospitals and health centers.
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Source: "MANDATORY HEALTH INSURANCE | THE FIRST YEAR: Progress and perils - Thousands more in state have coverage under ambitious program, but challenges lie ahead over funding and getting message out to all" (By Alice Dembner, (Boston) Globe Staff, April 22, 2007).
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So who dares calls this a failure, "Boston Globe Editorial Idiots!"?
I am your man! MASSACHUSETTS' NEW HEALTHCARE LAWS ARE A FAILURE!

Moreover, it is a SCAM to screw the common taxpayer --under the false pretense of publicly assisting the many disadvantaged families that are the common man, woman and child-- that really only redistributes taxpayer money from the common taxpayer to the state's select and elite Insurance Companies administering healthcare insurance plans to the state's diminishing middle class. Moreover, it even takes money away from the state's free-care pool, now used to pay for charity care at hospitals and health centers, and redistributes it to the state's Corporate Elite Insurance Companies instead of directly to the uninsured and underinsured needy people.

Massachusetts new healthcare laws should use taxpayer money to administer a single-payer, truly universal healthcare coverage plan for all of its +6 Million residents, but it does nothing of the sort.

You, Boston Globe Editors, are IDIOTS! I dare you to publish my letter! I know you won't because you cannot handle one thing in your daily print: THE TRUTH!

I will always speak my good conscience as long as I live!

In Dissent!
Jonathan A. Melle

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A Boston GLOBE EDITORIAL
"The health law is working"
February 10, 2008

DON'T BE fooled by the national press coverage suggesting the Massachusetts health plan is in trouble. The plan is suffering from a bit too much success, but the state has the resources to pay for it this year and next.

Enrollment in Commonwealth Care, the subsidized insurance offering, is higher than anticipated, but Governor Patrick and the Legislature are ready to pay the extra costs this year. In the fiscal year that begins this July, the governor has budgeted $869 million for Commonwealth Care, but over half that increase will be defrayed by the federal government. Rising costs are inevitable as the plan is rolled out.

Barring a financial collapse, the state will have the money to pay for the health initiative through fiscal 2009. In case more is needed, House Speaker Salvatore DiMasi and Senate President Therese Murray are talking about a cigarette tax increase. The Legislature will not let this initiative fail for want of money.

The state needs continued federal support for the plan. To seek this aid, it has to make three-year cost estimates. Much is uncertain about healthcare economics over the next few years, so it is wise not to panic about imprecise forecasts - in this case a $1.35 billion cost in 2011. Instead, providers, insurers, consumers, businesses, labor, and the government need to unite around a campaign to control costs.

Even though Massachusetts is a high-cost state, buffeted by competitors on all sides, and dependent on federal policies it cannot control, its elected representatives resolved to do what no state has ever attempted: require everyone (with hardship exemptions) to get health insurance and provide the means for most of them to afford it.

In a little less than two years, here's what Massachusetts has achieved:

Expanded Medicaid by 60,000 for the poor and near poor and children.

Established Commonwealth Care to provide insurance for adults living near poverty - more than 169,000 enrolled.

Created Commonwealth Choice policies for more affluent people - 16,000 enrolled.

Merged the individual and small-group markets so the self-employed can buy affordable insurance and encouraged businesses to set up programs so employees could get a tax savings on premiums - tens of thousands more enrolled in private insurance.

Structured an individual mandate so penalties only fall on those for whom affordable coverage is available.

Provided a national model to show how different interest groups can unite to support significant social progress.

Governor Arnold Schwarzenegger's plan to do something similar died in a California Senate committee recently. In Massachusetts, the coalition behind the health reform law is holding firm. The plan itself is creative and sound. Who dares call this a failure?

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2/27/2008

Dear Boston Globe Editorial Idiots!

You are missing the very point on "Healthcare Reform" in Massachusetts!

The State Government is presenting subsidized healthcare to the federal government in order to receive more federal funds and then give that federal taxpayer money to the state's corporate elite, wealthy insurance companies!

That is FRAUD!

Where is my proof? Well, Boston Globe Editorial Idiots!, here is my proof:

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"When passing the Massachusetts FY2008 State Budget, the state transferred $500 million from the Health Care Security Trust to make up the difference on the disputed figure for the budget deficit. Moreover, the state made the fiscally irresponsible decision to not make any interest payments and a $100 million contribution to this fund."

Source: "House lawmakers toss Patrick's plans", By Hillary Chabot, Transcript Statehouse Bureau, The North Adams Transcript, Thursday, April 12, 2007.

You, Boston Globe Editorial Idiots!, will find the cited news article on my Blog page explaining the Orwellian North Adams State Representative Dan Bosley:

www.jonathanmelleonpolitics.blogspot.com/2007/10/daniel-e-bosley-hypocritical-big.html

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You, Boston Globe Editorial Idiots!, wrote (below) today: "The connector is still negotiating with the four providers of Commonwealth Care over the overall cost of the insurance."

Well, Boston Globe Editorial Idiots!, you omit who the 5 Massachusetts insurers offering healthcare insurance are. Let me remind you:

5 Massachusetts insurers control about 90 percent of the healthcare insurance market in the Commonwealth of Massachusetts:

#1 - Blue Cross Blue Shield
#2 - Harvard Pilgrim Health Care
#3 - Fallon Community Health Plan
#4 - Health New England
#5 - Tufts Health Plan

Source: "200,000 may need to get more insurance: State healthcare law sets higher minimums" (By Alice Dembner, [The Boston]Globe Staff, January 30, 2007).

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Moreover, Boston Globe Editorial Idiots!, you fail to mention how the state is subsidizing healthcare insurance to its working poor residents. Well, let me remind you:

"The state's plan relies largely on two sources: federal funds that are committed only through June 30, 2008, and the state's free-care pool, now used to pay for charity care at hospitals and health centers."

Source: "MANDATORY HEALTH INSURANCE | THE FIRST YEAR: Progress and perils - Thousands more in state have coverage under ambitious program, but challenges lie ahead over funding and getting message out to all" (By Alice Dembner, (Boston) Globe Staff, April 22, 2007).

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In conclusion, what does this all mean? Well, it means that (a) during last year's budget season, the state used $600 Million (nominal, not actual) out of its Health Care Security Trust fiscal account to cover most of its FY2008 budget deficit instead of spending the federal dollars on "Healthcare Reform"; (b) 5 corporate elite, wealthy Massachusetts Insurance Companies are receiving the Federal Dollars the state receives for "Healthcare Reform" instead of the uninsured or underinsured; (c) "Healthcare Reform" relies on 2 main funding sources which exclude the state government spending one cent on their own policy; (d) Hospitals are now losing money to the 5 corporate elite, wealthy Massachusetts Insurance companies under "healthcare reform"; (e) and now the recipients of "healthcare reform" may be asked to pay increased premiums & fees a regressive revenue fee system in order to subsidize a program the state is asking the federal government to subsidize while the state uses nominal surplus funds to cover its recurring yearly budget deficits. "Healthcare Reform" in Massachusetts is a SCAM that transfers federal taxpayer dollars to the state's corporate elite, wealthy 5 insurance companies offering "subsidized" healthcare insurance and to the state to cover its recurring yearly budget deficits.

Lastly, I ask you, Boston Globe Editorial Idiots!, to please publish my email letter to you today. Please let the power and light of truth shine once more for the people the state government is supposed to be serving. Please publish this letter!

In Dissent!
Jonathan A. Melle
~Former lifelong resident of the Commonwealth of Massachusetts~

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A Boston GLOBE EDITORIAL:
"A fair share for healthcare"
February 27, 2008

THE AUTHORITY overseeing the state's new universal healthcare law is about to raise its rates on people who are living on limited incomes. This insurance is subsidized by the state, and the Commonwealth Health Insurance Connector Authority wants to make sure that co-pays and monthly premiums are high enough to discourage people from switching from private insurance. These costs should not be so high, however, that they are a burden for people with chronic conditions or discourage them from getting necessary care. When the connector board meets to set the rates tomorrow, actuarial prudence needs to be leavened by compassion.

Anyone in Commonwealth Care would face higher co-pays: $5 more for a prescription and $5 more for a visit to a primary care provider. That may not sound like much, but it adds up to a major burden for people with multiple ailments and several prescriptions, especially when it applies to those earning just above the federal poverty line - $10,400 a year for a single person.

And the monthly premium rates would go up for people from 150 percent to 300 percent of the poverty limit. Again, it might be just a few dollars a month, but when combined with increases in the cost of food and fuel, the total healthcare increase would strain the budgets of the very people that Commonwealth Care is designed to help.

Those premiums need to be high enough that people who can afford private insurance do not try to save money by flocking to the subsidized policies. Figures from the state Division of Health Care Finance and Policy show that the number of employers offering coverage was holding steady at a little more than 70 percent in 2007, the first full year of the Health Reform Law. No one knows what will happen this year, when uncertainty hangs over the economy, but there is as yet no compelling case for the connector to shift so much cost onto the insured.

The connector is still negotiating with the four providers of Commonwealth Care over the overall cost of the insurance. Rates will be going up, as they nearly always do. Yet one exception to this rule is the $295-per-worker penalty leveled on companies employing more than nine workers that do not offer insurance. The law mandates that the state reassess this figure every year to reflect the cost of living and usage of the free-care pool for the uninsured. Under the law, the penalty can go down, but it can never exceed $295.

The connector alone can't change that $295, but the Legislature ought to revisit the fee, at least to index it to the rate of healthcare inflation. The goal of the Health Reform Law - to cover nearly everyone in the state - is a shared responsibility that requires continual reassessment. If people on limited incomes must pay more, why not employers

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"Health care meeting canceled after insurance bids come in high"
The Associated Press (via Berkshire Eagle Online)
Thursday, February 28, 2008

BOSTON (AP) — New bids from four insurers who provide subsidized insurance under the state's universal health care law have come in far higher than expected.
Chairwoman Leslie Kirwan has canceled today's meeting of the Connector Board and instead is considering a public statement discussing the unanticipated cost growth and her hope the insurers can cut their proposed rate increases.

The insurers — Fallon Community Health Plan, BMC HealthNet Plan, Neighborhood Health Plan and Network Health — service the Commonwealth Care program. It provides subsidized health care to people earning up to three times the federal poverty level.

Last month, the board proposed raising co-payments on the 169,000 people covered by the program. The concern is the suggested rate increases won't be enough if coverage is more expensive than expected.

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"Who pays for health plan?"
The Boston Globe - Letters, Sunday, March 2, 2008

YOUR FEB. 27 editorial "A fair share for healthcare" calls on the Connector to leaven actuarial prudence with compassion. I'd be happy to settle for actuarial prudence. Controlling costs by pricing people out is not actuarially sound. As the Globe notes, even the smallest price increases can create insuperable barriers to accessing preventive, acute, and chronic care. They may produce short-term savings. But in the long term, this population would likely be sicker and require more, and more costly, care.

One only has to look at the growing numbers of large, self-insuring employers such as EMC and Pitney Bowes to see what works. They are eliminating barriers to needed care, and investing in the wellness of their workers, because it saves them money and slows the growth of their healthcare spending. It's good for their workers' health and for their bottom line. The Connector should be at least as actuarially prudent with taxpayers' money as EMC is with shareholders' investments.

BARBARA WATERS ROOP
Dr. JOHN D. GOODSON
Cochairpeople
Health Care for Massachusetts
Cambridge

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CERTAINLY THE Globe offers some credible commentary for controlling shared healthcare costs under Commonwealth Care ("A fair share for healthcare"). However, there are some figures missing in your analysis.

I run a small construction company with fewer than nine employees, but have offered health insurance for years, paying 50 percent of the premiums. As of April 1, these premiums will increase by 30 percent (thank you, Blue Cross and Blue Shield of Massachusetts). Combined with workers' compensation and liability insurance, a system that the Commonwealth does not monitor effectively, the cost of doing business has become staggering.

Our new quoted monthly rates are $699.71 (individual) and $1,835.34 (family). At these rates, it's difficult to perceive how the Commonwealth Health Insurance Connector Authority will be able to assure that, in your words, "monthly premiums are high enough to discourage people from switching from private insurance" while keeping healthcare costs within the reach of all citizens.

FRANK SARGENT
Carlisle

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DR. JOSEPH DORSEY and Dr. Donald Berwick's admiration of the kind of capitated managed care provided by salaried physicians in the former Harvard Community Health Plan is justified ("Dirty words in healthcare," Op-ed, Feb. 27). So is their suggestion that this kind of care might be just what our country needs.

But they did not mention two other critical features of HCHP, namely that it was not-for-profit, and that physicians, not business people, managed the medical care and allocation of medical resources.

So long as we allow our healthcare system to function as a market-driven, profit-making industry, influenced by investor-owned businesses and by physicians who have invested in the goods and services they use and prescribe, institutions like the old Harvard Community Health Plan are not likely to survive. What Dorsey and Berwick's argument really calls for is some kind of capitated single-payer system, supporting a reorganized not-for-profit healthcare delivery system.

Dr. ARNOLD S. RELMAN
Boston
The writer is former editor of the New England Journal of Medicine.

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I AGREE with Dorsey and Berwick that capitation is the best way to pay providers of healthcare. However, their accusation that insurance companies "hijacked" managed healthcare is unfair. The detested interference by those companies in medical decision-making was in response to the failure of provider organizations to prevent the unnecessary use of expensive services. Or, to put it in fewer words, in the failure of providers to manage care. Like Dorsey and Berwick, I think capitation ought to be tried again. But it will succeed only if providers are able and willing to be effective managers of care.

RICHARD WITTRUP
Scituate

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CRITICAL OF the "minimal" penalties to be levied against employers who opt out of Commonwealth Care, David Schreiber urges the state to raise the sanctions against employers who do not (or perhaps cannot) provide coverage for their workers ("Hit up relatively untapped source in health reform," Letters, Feb. 25). He tells the Connector Authority to go "where the money is." May I suggest that employers and employees alike, in businesses large and small, are tired of taking the hit for costly health insurance. The Connector knows very well where the money is, and why costs are rising. The Massachusetts plan protects the profit stream of private insurers. Only a national taxpayer-funded single payer plan would distribute cost and risk equitably. No mandates, no penalties, no complicated "connectors."

HARRIETTE SEILER
Louisville, Ky.

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"Health care question can't go on ballot without legislative OK"
The Berkshire Eagle Online, The Associated Press
Monday, March 10, 2008

BOSTON (AP) — The state's highest court won't force the secretary of state to put a proposed health care question on the ballot despite the Legislature's failure to vote on the measure.

The proposed constitutional amendment would guarantee comprehensive and affordable health coverage for all residents.

Lawmakers overwhelmingly approved the measure on an initial vote in 2004, but let it die without taking a needed second vote.

Supporters asked the state Supreme Judicial Court to put the question on the ballot anyway.

The court said that while the constitution required the second vote, it has no way of forcing lawmakers to act.

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(A Boston) GLOBE EDITORIAL
"Who said it would be easy?"
April 8, 2008

IT MIGHT have made more sense economically if a lower-cost state - say, Utah or Minnesota - had initiated the health insurance expansion that became law in Massachusetts two years ago this week. But the political and economic leadership here had the will and the resources to try what no state, except Hawaii, had ever come close to achieving: health coverage for just about everyone. While the success of this initiative is not assured, Massachusetts should be proud of accomplishing so much, so quickly.

As of Jan. 1, 342,000 people had enrolled in insurance plans fostered by the new law, an impressive achievement. Two-thirds of that number are in Commonwealth Care, which provides subsidized coverage to those just above the poverty line.

According to the Kaiser Family Foundation, healthcare costs much more in Massachusetts than elsewhere: $6,683 per person in 2004, compared with Utah's $3,972, and Minnesota's more typical $5,795. Yet in the short term, this cost disparity meant Massachusetts had more money in the system to expand coverage - notably from a Medicaid waiver by the federal government, which comes up for renewal on July 1.

Support for the Massachusetts initiative has been a major achievement of the US Department of Health and Human Services. Secretary Michael Leavitt, who has the final say, ought to approve an extension.

Even with a renewal, unforeseen costs will become a burden. More people have signed up for Commonwealth Care than anticipated and rates are going up 9.4 percent July 1. Governor Patrick budgeted $869 million for the initiative in the fiscal year that begins July 1, but his administration now believes that figure is low by $100 million.

If only this were Utah, where the healthy Mormon lifestyle keeps costs down, or Minnesota, which is not so dominated by expensive teaching hospitals and specialists. But Massachusetts has one great advantage over other states - the coalition of groups that put the healthcare package together two years ago. This includes businesses, health insurers, hospitals, unions, healthcare advocates, and political leaders. They now need to figure out ways to control costs, maintain quality, and get new money into the system when absolutely necessary.

A generation ago, Hawaii was praised for requiring employers to provide health insurance to all workers. Companies found loopholes, however, and as of 2006, its uninsurance rate was 10 percent, a little less than Massachusetts's 11 percent.

The Massachusetts initiative will fray more quickly unless the coalition reenergizes itself.

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A Boston GLOBE EDITORIAL
"Health reform is working"
June 4, 2008

THE 350 PEOPLE who packed into the main conference room of the John F. Kennedy Library yesterday were in a good mood. They were about to hear a report that implementation of the Massachusetts health reform law had, in less than two years, cut the number of uninsured people of working age nearly in half. Then they got the bad news from House Speaker Salvatore DiMasi, one of the progenitors of the law: "The third year . . . will be the most difficult."

The law has resulted in health insurance coverage for 355,000 people, but it is costing more than expected, and it was mainly funded by two uncertain revenue sources: money that would otherwise go to hospitals to treat the uninsured, and a special waiver of federal Medicaid rules. The waiver, which freed up money to expand insurance coverage, expires in less than a month. A renewal seems likely, but it's unclear how much money the state will receive.

And the law hasn't done anything to alter treatment patterns that have burdened Massachusetts with some of the nation's highest medical costs. "We must contain costs," said Senate President Therese Murray. "We must stay together and be fully committed to the second phase of healthcare reform."

A far-reaching cost containment bill supported by Murray has cleared the Senate and is awaiting House action, which DiMasi promised is coming soon. Among other things, the bill calls for more transparency by insurance companies, a statewide system of electronic health records, better recruitment of primary-care doctors, and a ban on gifts from drug companies to physicians.

This last item has provoked opposition from the catering industry. Drug companies would no longer be able to roll out free lunches to attract physicians to informational meetings. But a doctor's prescription patterns should not be swayed, even a little bit, by food or other gifts. Murray's proposal should become law.

A ban on free lunches is nothing compared to the other changes that will be required to make health reform work. Hospitals will need to make sure that expensive procedures actually produce results. Insurers will need to devise payment systems that reward quality, not just quantity of care. Patients will need to be more cost-conscious, especially about unnecessary visits to emergency rooms.

In 2004, when the Blue Cross Blue Shield of Massachusetts Foundation convened the first meetings to solve the unemployment problem in Massachusetts, few would have thought the state could have advanced so far, so fast. The task is still daunting, but the commitment remains strong.

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(A Boston) GLOBE EDITORIAL
"Keep health reform moving"
June 19, 2008

IN JULY 2006, US Health and Human Services Secretary Michael Leavitt praised the Massachusetts health insurance plan as a national model. He was in Boston then to announce the extension of the special Medicaid funding that enabled Massachusetts to expand coverage to nearly everyone. Leavitt needs to quickly extend this money, which is available through a waiver of Medicare rules, so that the state's landmark initiative can continue.

Governor Patrick is meeting with Leavitt tomorrow to discuss renewal of the waiver, which expires June 30. Patrick might recall the words of his predecessor, Republican Mitt Romney, who told Leavitt in 2006: "Massachusetts is now at the forefront of a revolution in the way we think about healthcare." He added, "The reforms we crafted bring coverage to all our citizens."

Romney was indulging in a bit of hyperbole. The state hasn't managed to cover everybody, but a study by the Washington-based Urban Institute found that 93 percent of the working population had health insurance as of last fall. Sharon Long, researcher on the study, figures that if children and the elderly are included, the total insured population in Massachusetts exceeded 95 percent, an extraordinary figure given that the national rate was about 84 percent in 2006, the year with the latest Census figures.

"None of us should expect perfection here," Leavitt said in 2006. "Mistakes are going to be made."

The Legislature has provided an adequate share of money. The new healthcare connector authority has created subsidized coverage for those just above the poverty line. Private companies have written policies for these people, and for those who can afford unsubsidized insurance. The experiment has gone well, with one exception: The state underestimated the number of people who would enroll in subsidized plans.

It's unclear how much money is involved in the waiver renewal negotiations, but the amount is sure to exceed the $625 million annual federal contribution under the current plan. The governor and Legislature are ready to provide money to accommodate extra enrollment, but they need help.

Many people contributed to the passage of the healthcare law in 2006, notably Romney, Leavitt, and his predecessor Tommy Thompson - all Republicans - along with Senator Edward M. Kennedy and the Democratic legislative leadership. Leavitt said then that "every component of our society" needs to contribute to providing access to affordable, basic healthcare. Massachusetts has shown it can be done. The Bush administration, led by Leavitt, needs to help maintain progress toward this bipartisan goal.

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The Boston Globe, Saturday, June 21, 2008, Page B2, City & Region

“Patrick reaches deal on Medicaid waiver”

Governor Deval Patrick has reached a deal with the Bush administration to give Massachusetts a 2-to-4-week extension of a critical Medicaid waiver. An official familiar with a meeting between Patrick and Health & Human Services Secretary Mike Leavitt said they reached an agreement yesterday, Friday, June 20, 2008. The extra time will let the parties negotiate a further extension to a $400 million Medicaid waiver that has powered the state’s universal healthcare program. Senator Edward M. Kennedy called Leavitt on Thursday, June 19, 2008, to push for the extension. (AP)

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"Business balking at health changes: Many firms and insurers oppose $100m price tag; Public backs Patrick idea to close gap in funding"
By Kay Lazar, (Boston) Globe Staff, July 15, 2008

Governor Deval Patrick's proposal to ask businesses, insurers, and hospitals to kick in about $100 million to close a gap in funding for the state's landmark health insurance law is threatening to fracture the fragile coalition whose support was instrumental in passing the measure.

Business and insurance industry leaders are opposed to Patrick's plan, saying it is unfair to ask them to pay more, especially during an economic downturn. But consumer groups praised the proposal, saying patients were asked to pay more when copayments and deductibles for subsidized health plans were increased earlier this year. Now, they say, it is time for others to step up and pay their share.

Meanwhile, a new poll indicated there is broad public support for asking businesses and insurers to pay more to keep afloat the state's health insurance law, which seeks to cover almost all residents.

But a lobbyist with the state's largest business group said Patrick's proposal is likely to undermine key support for the two-year-old law, which passed only after more than a year of sensitive negotiations and compromises involving hospitals, insurers, employers, and consumer groups.

"It was a real delicate balance that was achieved two years ago to bring everybody on board," said Rick Lord, president and chief executive of Associated Industries of Massachusetts, an association of business groups with 7,000 members.

"This jeopardizes the support of the business community, and that's one of the reasons reform has been so successful so far," he said. "Any reform that has been tried anywhere else - when the business community opposed it, reform has not been successful."

The law requires most employers to offer health coverage or to pay an annual penalty of $295 per worker. But a crucial compromise was struck to win the business community's support: companies would be in compliance even if a minority of their workers were covered. Employers with more than 10 workers had the option of paying at least 33 percent of workers' premiums within their first 90 days of employment or having at least 25 percent of their workers covered by an employer plan.

Patrick's proposal would raise $33 million in additional penalties by requiring employers to meet both requirements.

Lord said the proposal would hit retailers especially hard, because many of them face such high turnover that they do not typically offer health insurance to full-timers until after 90 days.

The governor announced the plan Sunday as part of a supplemental budget request, which must be voted on by the Legislature. In a letter to legislators, Patrick described the proposal as modest and as "companion contributions to those already made by consumers." House Speaker Salvatore F. DiMasi promised yesterday there will be a "full examination" of the proposal.

Patrick's plan would raise another $33 million from an assessment on insurance companies' reserve accounts. But Dr. Marylou Buyse, president and chief executive of the Massachusetts Association of Health Plans, said that the money is needed by the companies to cover catastrophic health costs in the event of a flu pandemic or a terrorist attack.

"This is taxing healthcare to pay for healthcare and is not solving the basic problem, which is healthcare costs too much," said Buyse, whose group represents most of the state's health insurers.

The state's largest private health insurer, Blue Cross Blue Shield of Massachusetts, hasn't taken any position on the proposal. A spokesman said the governor needs to release more details before the company could assess the full impact.

The state's hospitals are supporting the request for more money - $28 million from hospitals - with a caveat. Hospitals are willing to pay more to make near-universal healthcare work, said Lynn Nicholas, chief executive of the Massachusetts Hospital Association, but she tied the organization's support to the defeat of an unrelated measure pending in the Senate. That bill would set minimum nurse staffing requirements and require hospitals to hire more nurses.

The cost of Patrick's plan "pales in comparison to the prospect of having government-mandated nurse staffing ratios, which could cost in excess of $200 million a year," Nicholas said.

Most of the extra money from hospitals would go to a pool that covers hospital costs of residents who remain uninsured. Currently, the hospitals contribute $160 million to that fund.

Consumer groups are enthusiastically supporting Patrick's plan. "Consumers have already stepped up to the plate," said the Rev. Hurmon Hamilton, president of the Greater Boston Interfaith Organization, a consortium of religious and civic groups. "I would strongly urge the business community, insurance, and hospitals . . . to come forth and do their part."

Patrick also wants to plug the funding gap by shifting $35 million from the Medical Security Trust Fund, which is used to pay health insurance for the unemployed. Consumer groups were skeptical of that part of his plan.

"Unemployment is going up as the economy worsens, and we want to make sure there is enough money left to pay unemployment to people who are entitled to the money," said Brian Rosman, research director for Health Care for All.

Asking businesses and insurers to pay more toward healthcare is popular. A poll being released today by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation found that nearly three-quarters of those surveyed supported requiring businesses with more than 10 employees to pay more toward the system. And 61 percent said they favored requiring insurers to contribute more to a fund that would subsidize coverage. The poll of 1,015 Massachusetts adults was conducted June 10 to 23.
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Kay Lazar can be reached at klazar@globe.com. Globe writer Eric Moskowitz contributed to this report.
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A Boston GLOBE EDITORIAL
"Patrick makes a tough choice"
July 15, 2008

THE GOOD news is that enrollment in the state's new subsidized health insurance program has greatly exceeded projections. The bad news is that this has raised the first-year cost of Commonwealth Care from an expected $472 million to $630 million. To fill the gap, the Patrick administration has devised a plan that spreads the pain relatively equally among health reform's major stakeholders, from providers to employers to insurers and the state itself.

The most important stakeholders - the individuals and families who have signed up for the state's pioneering effort at universal coverage - have already done their bit. In April, their premiums rose 10 percent and their co-payments also increased. The Legislature should approve the governor's proposal or come up with a better one before it adjourns at the end of this month.

Under the governor's plan, an employer would have to pay an annual assessment of $295 per uninsured worker unless it offers a health plan enrolling at least 25 percent of its workers and pays at least 33 percent of its employees' health premiums. Until now, employers have been able to avoid the assessment if they met either criterion. The state calculates this change would hike employer assessments by $33 million. Insurers would face a one-time assessment of $33 million, and providers would have to kick in $28 million. The state would draw up to $35 million from a surplus in a fund for health insurance for the unemployed.

If lawmakers do not act, the alternatives are sobering. The state could reduce spending for other programs or further increase charges to subscribers, putting coverage beyond the reach of some. Or it could cut off enrollment in Commonwealth Care. But this would not only leave consumers without access to affordable coverage, it would also probably make it impossible for the state to enforce the mandate on individuals to get insurance. Thanks to Commonwealth Care, the mandate, and other elements of the state's reform plan, a recent survey found that the percentage of uninsured in the state had fallen from 13 percent in the fall of 2006 to 7 percent last fall.

A poll released today by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation found strong public support for health reform and a 66 percent majority against capping enrollment in Commonwealth Care to limit its costs. To keep that backing, legislators should quickly find a way to pay for Commonwealth Care's success without gutting other state programs or putting an undue burden on the newly insured. The Patrick plan to achieve this is a good start.

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"Health plan's rising cost"
The Berkshire Eagle - Editorial
Wednesday, July 16, 2008

The state's innovative health care program met its first financial crisis in April and weathered it by raising premiums and co-payments for participants. Now the wolf is at the door again, and it is the business community that Governor Patrick wants to dig deep to help close a $100 million funding gap. In a sense the program is a victim of its own success, but it is more clearly the victim of flaws in our health care system that its architects failed to or couldn't steer clear of.

The admirable goal of the state-subsidized Commonwealth Care program is to provide insurance for everyone in the state, and it has done an impressive job of lowering the uninsured rate in Massachusetts to just 7 percent. Families at or below the poverty level are now getting health care. Predictably, however, costs have increased, and at an estimated $630 million, the program's first-year costs are now about $150 million higher than planned.

The governor wants to raise $33 million by subjecting businesses that don't meet requirements for insuring employees to penalties they were not subjected to when business leaders originally signed off on the plan. The state's hospitals will agree to pay an additional $28 million as requested but only if Beacon Hill agrees to abandon an unrelated bill requiring minimum nursing requirements. Blue Cross Blue Shield is pondering the governor's proposal that insurers pitch in more money. The governor wants to shift $35 million from health insurance for the unemployed, a risky idea in this dismal economic climate.

It's unfortunate that Commonwealth Care funding pits consumers and businesses and hospitals against one another when they are all in the same bind. But because the plan doesn't address the insurance companies at the center of our broken health system, that was the unfortunate and inevitable result.

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(A Boston) GLOBE EDITORIAL
"Find the money soon"
July 24, 2008

TO NO ONE’S surprise, employers are responding with Bronx cheers to Governor Patrick’s plan to get more fees from them for the state’s subsidized health insurance program. The state’s bid for increased assessments from businesses, insurers, and healthcare providers comes just as the economy shows signs of weakening.

In the spirit of keeping together these groups and others that have collaborated on the state’s pioneering attempt at universal coverage, the governor’s team should consider any reasonable alternatives to the new assessments. However, one that has been prominently mentioned — shifting more Medicaid members to managed care plans — seems unlikely to produce the immediate savings needed.

At the heart of the problem is the state’s estimate that subsidized Commonwealth Care coverage and Medicaid will cost the state at least $120 million more than projected. To close the gap, the governor wants to collect an additional $33 million from insurers, $28 million from providers, and $33 million from employers who do not have health plans enrolling at least 25 percent of their workers and who do not pay at least 33 percent of workers’ premiums. The state itself would provide up to $35 million from a fund for insurance for the unemployed. Commonwealth Care’s members already began paying higher premiums and co-payments this spring.

As an alternative to new fees, a coalition of businesses and insurers thinks the state could save $160 million by enrolling all 1.1 million Medicaid members in managed care plans. Currently, 400,000 are in such plans. According to the Executive Office of Health and Human Services, managed care plans have historically served the healthiest Medicaid recipients but ‘‘have not yet demonstrated the capacity to serve large numbers of disabled members.’’ The state is starting to bring in new plans with more expertise in serving members with complicated care requirements. But changes in this direction will have to be measured to work well and probably won’t produce much savings in the short term.

The debate over closing the Commonwealth Care gap will inevitably have echoes in Washington, where the state and the Bush administration are negotiating over a Medicaid waiver with hundreds of millions of dollars at stake. The state’s bargaining position will be stronger if it can demonstrate that all stakeholders in health reform — insurers, providers, consumers, and employers — are doing their part to make reform work. That means, on the state’s side, considering all cost-saving proposals. But it also means that, in the end, everyone else might have to pony up more money.

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(A Boston) GLOBE EDITORIAL
"Checks on the state's to-do list"
August 6, 2008

VOTERS ARE said to like divided government, with one party heading the executive branch while another controls the Legislature. This is supposed to provide checks and balances, but just as often it can result in gridlock. The session just completed shows that much can be accomplished when the two branches work together - provided everyone agrees to share the credit.

Deval Patrick was the first Democrat elected governor in 16 years, but the Democratic Legislature did not march in lockstep behind all his policy proposals. The defeat of casino gambling and criminal justice reform, stalled property tax relief, and $122 million in budget vetoes are proof of that.

Rather, Patrick, legislative leaders, and especially their staffs did the unsexy policy work needed to cobble together strategies for the big issues facing states today. The result: A $1 billion life sciences initiative; a sweeping energy bill with a focus on conservation and renewables; a $3 billion bond to accelerate repairs on deteriorating roads and bridges; $500 million in new revenues; an intact health reform law with 340,000 new patients enrolled in insurance plans. "Green" causes fared particularly well, with the biggest environmental bond bill ever, and commitments to carbon reduction and open-space preservation.

Personality clashes sometimes substituted for ideological differences, however. The governor got off to a rocky start with the House Speaker Salvatore DiMasi and Senate President Therese Murray, themselves fairly new to the job. But in an interview yesterday Patrick said, "we play the long game." Over time, the three focused on getting to yes.

Some in the business community have complained of rising costs in these initiatives, pointing to tax loophole closings, new environmental regulations, and increased contributions to the healthcare law. But Patrick was scrupulous about seating business representatives at the table while the big changes were hammered out, to the benefit of corporate interests. For example, the tax loophole closings and cigarette tax hike were partly offset by an overall reduction in the corporate tax rate.

Plus, as the state GOP likes to boast, taxes were cut more than 40 times by four successive Republican administrations. Given plunging revenues and the press of healthcare and other needs, the fairly modest tax hikes are more a course correction than a radical shift.

Former Governor Weld, who started the 16-year run of Republicans in the corner office, liked to say that government should "steer, not row." But this past session suggests what is possible when most oars are pulling in the same direction.

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"Fourth delay in care plan sought: US balks at hike proposed in yearly Medicaid funding"
By Kay Lazar, (Boston) Globe Staff, August 9, 2008

Federal regulators are balking at the state's proposal to increase Medicaid spending by up to $1 billion a year over the next three years, and this and other sticking points prompted Massachusetts yesterday to request another two-week extension of its healthcare funding package.

The federal payments, which are crucial for keeping the state's landmark health insurance law afloat, were set to expire June 30, but the state has received three extensions, and a fourth would postpone the deadline for reaching an agreement until Aug. 25.

At stake in the negotiations between state and federal officials is more than $11 billion in federal funds over three years, money earmarked for dozens of healthcare programs in Massachusetts in addition to the state's crown jewel: its two-year-old near-universal health coverage law that has provided insurance to more than 350,000 residents.

Medicaid is a state and federally funded program that provides healthcare assistance to low income people. Over the past decade, Massachusetts has been granted waivers from Medicaid rules to expand assistance to residents who wouldn't otherwise be eligible for coverage.

Federal rules require that the expanded coverage not cost more than would have been spent without the waivers, and the figure itself is one area of disagreement, according to a key legislator and other people familiar with the talks.

"If we don't get everything we are looking for in the waiver, we would either have to come up with the money through [state] reserves, or we would have to cut benefits," said Senator Steven Panagiotakos, chairman of the Senate Ways and Means Committee.

Panagiotakos, who has been regularly briefed by the administration of Governor Deval Patrick, declined to discuss specifics but said state negotiators seemed cautiously optimistic about the progress of the discussions. But he said that the two sides are still in disagreement over funding for several key programs in the massive spending blueprint, and that if Massachusetts did not get what it requested for any one of those programs, it could have a large impact on the state budget.

Several others familiar with the talks said that the state is pushing for higher spending because it expects at least 50,000 more residents to sign up in the next year for Commonwealth Care, a subsidized health insurance program for lower-income residents ineligible for Medicaid.

The higher-than anticipated enrollment in Commonwealth Care has stretched state funds, and the dispute with federal regulators comes at a time when Massachusetts has little wiggle room, with a tight budget and declining revenues.

Yet the state's Medicaid proposal for the next three years shows a growth in spending each year that is roughly double what it had been in years past.

Another critical point of disagreement between state and federal negotiators, people familiar with the talks say, is the way Massachusetts has counted the number of children enrolled in MassHealth, the name of the Massachusetts Medicaid program. They said federal regulators believe the state has, for years, incorrectly listed many children under MassHealth when they should have been counted under a program called the State Children's Health Insurance Program, which is not funded by Medicaid.

The difference made it appear that Massachusetts had a much larger number of children in MassHealth, and that made the state eligible for more federal reimbursement in its Medicaid program.

The Patrick administration has declined to discuss details of the sensitive negotiations. But late Wednesday, a federal government spokeswoman released a statement that indicated the talks were nearing completion.

"The US Department of Health and Human Services has extended an offer to the State that is faithful to the intent of the original . . . Medicaid [waiver]," said the written statement from Christina Pearson, agency spokeswoman.

"The offer continues HHS' commitment to the shared principles of health care reform under the (Medicaid waiver) program and maintains its support for the Commonwealth as the State continues to be an innovator in this endeavor," the statement continued.

But Patrick administration officials denied that any offer had been extended. Shortly after that, Pearson backed off the statement that an offer had been extended.

"There is not a formal offer on the table," Pearson said in an e-mail on Thursday. "What we did provide recently was more feedback, specifics, and ideas on how to proceed. Since it is an ongoing dialogue, we will not have further comment on our discussions."
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Kay Lazar can be reached at klazar@globe.com.
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www.boston.com/news/local/articles/2008/08/09/fourth_delay_in_care_plan_sought/
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(A Boston) GLOBE EDITORIAL
"The trauma of high costs"
August 22, 2008

ON THE same day that Moody's rating agency declared that runaway medical costs are making the Massachusetts universal health plan unsustainable, Tufts Medical Center in Boston announced a plan to become a state-designated trauma center. The money needed for this upgrade would add to the costs that patients and employers must bear when they use Tufts services. If Boston were lacking in trauma centers, the investment would make sense, but the city already has four: Boston Medical Center, Brigham and Women's, Beth Israel Deaconess, and Massachusetts General. It needs another trauma center like it needs another sports bar.

Trauma centers treat the victims of gunshots, stabbings, car collisions, and falls. They must have the staff and facilities to do, at short notice, complex surgeries, including neurosurgery, with access to quick imaging and laboratory results. Once a hospital's trauma facilities win the approval of the American College of Surgeons, the hospital can apply for designation by the state Department of Public Health. With designation by the state, a center is more likely to get trauma victims brought by ambulances.

Unfortunately, under current rules, trauma centers are not subject to the state's "determination of need" process, so the state cannot reject the application on the grounds that Boston already has more than enough trauma capacity. The state should change the rules to include oversight of the centers.

If Tufts were in Western Massachusetts, where trauma centers are few and far apart, its proposal might make sense. But in Boston, no one needing trauma care lives more than a few miles from a center.

Tufts Medical Center's chief executive, Ellen Zane, argues that while the Longwood medical area has two adult and one pediatric trauma center, even though it has relatively few residents, the Chinatown neighborhood of her center is densely populated and has none. But traumatic injuries don't always occur near home, and most state residents would be happy to be as close to quality trauma centers as Chinatown is. Zane also argues that because Tufts already has a pediatric trauma center, creating an adult one will require little additional expense.

Massachusetts is trying to achieve universal healthcare despite having the highest per-capita health expenditures in the nation. The state's outstanding teaching hospitals, including Tufts Medical Center, are one factor raising health costs here. The gloomy prediction from Moody's that universal care is unaffordable could prove true if all involved in healthcare do not strive to keep outlays down. Four trauma centers in Boston are plenty.

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(A Boston) GLOBE EDITORIAL
"Keep this experiment going"
September 5, 2008

BECAUSE of the state's bold experiment in broadening health coverage, Massachusetts now has the highest rate of insured residents in the country - 94.6 percent, according to recent census data. But the cost of progress has risen, as more and more of the uninsured sign up for the state's subsidized Commonwealth Care plan. Once estimated at $472 million in its first year, the bill came in at $630 million.

Even so, Massachusetts must keep this experiment going. Today, a state agency will hold a hearing on a sensible proposal by the Patrick administration to close the gap - it wants to collect from more businesses that are not doing a good job of providing insurance for their employees.

Under the plan's original design, a firm with 11 employees or more would have to pay the state a modest $295 a year for each uninsured worker if the company does not insure 25 percent of its full-time employees or provide 33 percent of its workers' premiums. The Patrick administration wants to change that so that companies can escape the $295 fee only if they insure 25 percent of their workforce and provide 33 percent of premiums.

With this tougher standard, it is estimated that revenue from the penalty fee will jump from $7.4 million this year to more than $40 million.

Employers are not the only stakeholders in the healthcare reform plan who will have to give more than first expected under the administration's adjustments. In April, those insured by Commonwealth Care had to swallow a 10 percent increase in premiums, and higher copays as well. The Legislature has increased the assessment on hospitals by $20 million, and took $38 million from insurance companies with excess reserves. The state itself is also kicking in $35 million from a health fund for the unemployed that is running a surplus.

All of this will ensure that the state does not have to close off enrollment in Commonwealth Care, a step that would strike at the heart of the landmark Massachusetts law. The plan has broken new ground by mandating that individuals must get insurance in one way or another. Results are so encouraging that it recently won praise even from Mitt Romney, who helped design it when he was governor but has blown hot and cold over it since.

But it would be impossible for the state to mandate insurance if it could not provide subsidized coverage to all who are eligible. Collecting from more businesses that are not doing enough to provide coverage to their workers is a good way to keep the state's promise of universal coverage alive.

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(A Boston) GLOBE EDITORIAL
"Worlds apart on healthcare"
September 21, 2008

ON FEW ISSUES do Barack Obama and John McCain diverge as dramatically as they do on healthcare. Both say they want to reduce costs and expand coverage to the 47 million uninsured. But while Obama wants to build on the existing employer-based system with new coverage plans for families and businesses, McCain aims to move the country away from work-based insurance and toward a system in which all Americans cut their own deals with private insurers.

If the national campaign ever gets past lipstick and the collapse of investment banks, these differences on healthcare may get the attention they deserve.

The Massachusetts model
Obama's plan is like the new Massachusetts universal coverage law with one exception: There is no mandate on individuals to get insurance or pay a penalty. Just as this state did, he would expand government subsidies and programs for the uninsured. His proposed National Health Insurance Exchange looks like Commonwealth Choice, this state's lineup of heavily regulated private insurance plans for people without work-based insurance. In Massachusetts, 94.6 percent of residents now have insurance. Without the mandate, Obama's plan would never come as close to universal coverage, but it would expand coverage.

McCain, on the other hand, would use the tax code to shift insurance from the workplace to the marketplace. Under his plan, employees would start having to pay income tax on the value of the healthcare premiums they receive from their employers, making it a less attractive benefit. At the same time, McCain offers a tax credit of $2,500 for individuals and $5,000 for families toward the cost of coverage at work or in the private, nongroup market.

The upshot, analysts say, is that many young, healthy workers would reject their employers' taxable insurance benefit and either go without or find a high-deductible, low-premium policy on the private market. This would leave employers with an insured base of older, less healthy workers, which would drive up the cost of their insurance. The likely result is that many companies would drop coverage altogether.

Currently, about 60 percent of all Americans, 180 million people, get health insurance through their own job or that of a family member. A major drawback is that the insurance is not portable when an employee quits, gets laid off, or moves to a new position. But the group rates that employer-based insurance affords have kept its cost manageable. This has been the bulwark of health insurance since World War II.

After a Republican primary campaign in which candidates and debate moderators rarely mentioned healthcare, healthcare specialists are beginning to take notice of the radical base of McCain's plan. David Snow, the CEO of Medco, the largest US manager of drug benefits, told the National Press Club this month that McCain's plan "will create chaos." Robert Laszewski, a Washington-based consultant on benefits, has said that under the McCain plan most companies would stop paying for healthcare in three to four years.

McCain would not lament this. In his vision, the best way to cut costs in the system is to have many private insurers competing for the premiums of individuals by driving hard bargains with hospitals, doctors, and other providers. Critics of the McCain plan, including four health economics experts who discuss it in the current issue of Health Affairs, point out that nongroup coverage carries such high administrative costs that consumers are likely to find themselves paying higher premiums for thinner protection.

Healthcare just for the healthy?
Another danger with the McCain plan is that these nongroup insurers would compete by cherry-picking the healthiest individuals to cover and charging steep premiums to those with preexisting conditions or family histories of diseases. McCain's answer to this is that he would work with the states to expand the existing system of "high-risk pools" for the hard to insure. But these plans charge such high premiums with such limited benefits that in 2006 fewer than 200,000 people had enrolled in them.

Obama hopes to curb the rise in health costs through more preventive care. Getting more people insured will improve prevention, he believes, as will reimbursing doctors for outreach to patients.

The Massachusetts experiment will test whether better access to healthcare does pay off in improved prevention and lower costs. There is no comparable lab test, however, for the radical revision of healthcare that McCain is proposing. For all of his moderate positions on immigration and climate change, on healthcare he has endorsed a right-wing ideologue's vision: destroy employer-based coverage and turn Americans over to the tender mercies of private nongroup insurers in an unregulated environment. It's a prescription for disaster.

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A BOSTON GLOBE EDITORIAL
"Nine wishes for 2009"
January 1, 2009

FEW New Year's Days have been imbued with as much hope as this dawning of 2009. No doubt the fervent finger-crossing is so great because it matches the level of national anxiety, especially about the teetering economy. But today, with a year of possibility stretched out before us like pristine snow, is a time for optimism. So we offer these nine good wishes for 2009, in hopes of a better world - from the Globe's backyard to places far outside the circulation area.

1. We wish strength and wisdom for Barack Obama. The president-elect has an In box overflowing with challenges. We hope he keeps his head while navigating the perilous interest-group politics that his election has not banished from Washington. The immense goodwill greeting this historic presidency needs to be harnessed to propel the nation out of the current desolating recession, with its rippling job losses, housing foreclosures, and credit freezes. States and cities, where services for the neediest are dispensed, are facing extreme budget shortfalls of their own and require a boost from Washington. But Obama and his advisers need to take care, when dispensing the crucial billions in stimulus dollars, not to turn balm into boondoggle. Meanwhile, there needs to be accountability for the banks, Wall Street sharpies, and federal officials who allowed years of economic voodoo in the mortgage and financial markets to bloom into this crisis.

2. We wish for a lively, respectful challenge to Mayor Menino. This fall the mayor is almost certainly going to stand for an unprecedented fifth term as chief executive of our beloved city, and he should not get a free ride. Much as we support the mayor on many initiatives, there is always room for new ideas and fresh thinking. After almost 16 years with Menino in office, progress in Boston is only halting on crime reduction, education, civic engagement, and downtown development. It is time for a serious evaluation. We hope Menino doesn't adopt a Rose Garden strategy and avoid engaging his potential opponents; there should be plenty of debates, especially if the preliminary campaign draws more than one challenger, which we also hope for. In addition, there is a good chance that two or three City Council seats will open up this year, and we hope to see new candidates step up to run - inspired by Obama's example, perhaps - from the city's many communities of color.

3. We hope the temperature keeps turned up on global warming action. The Obama administration may be tempted to put the issue of climate change on the back burner while it copes with the economy. It should not, because the United States must lead if the world is to agree in 2009 on a successor to the expiring Kyoto protocol. If the new president presses the issue, Congress should finally have the votes to put a tax on carbon or create a cap-and-trade system on emissions. And there is a way to keep either measure from burdening the economic recovery: return the revenues from a carbon tax or from the sale of emission allowances to the public in the form of reduced personal taxes or more immediate investments in green technology. Obama's campaign talked about investing $15 billion a year for 10 years on green technologies, an amount dwarfed by the financial bailouts and economic stimulus plans of the past few months. The way to get consumers to choose more sustainable energy alternatives is to make them ubiquitous - and affordable.

4. We hope ethical government makes a comeback. From bucolic towns such as Hamilton to Boston City Hall and Beacon Hill, far too many public officials been found - allegedly - with their hands in the till. Governor Patrick's anti-corruption task force needs to come up with more than obvious quick-fix solutions such as increasing fines for violators. A good start for the next legislative session would be a cold-eyed look at the state and municipal pension systems, which have been tarred by high-profile abuses. And Patrick should more actively champion clean government. It is possible to defend public service as an honorable calling while showing no tolerance for corruption. In fact, the two go hand in hand.

5. The ethical cloud hanging over the Legislature will complicate the intricate dance needed to pass important policy changes. But we hope Beacon Hill finds the will to address the state's transportation crisis. The expected federal stimulus package, large as it is, will not be sufficient to address the $19 billion in deferred maintenance on the state's roads, bridges, and rails, nor all of the $4.7 billion in "shovel-ready" plans on Patrick's own wish list. Especially crucial in hard times is a functioning public transportation system, and the MBTA is a woeful mess. Transportation will be Patrick's priority issue for 2009. It is time for him to lead the Legislature toward sanity and equity in transportation funding by raising the gasoline tax for the first time in 18 years - and by enough to make it count.

6. The planets at last seem to be aligning for significant national progress on universal health insurance. So we hope the state's landmark healthcare law survives the fiscal storm. The recession is cutting state revenues needed to subsidize both the newly insured themselves and the hospitals and community health centers that treat disproportionate numbers of low-income patients. Layoffs will also increase the ranks of those who lose work-based coverage and need the state-subsidized programs. If the state's experiment is to serve as a national model, it must demonstrate that it is not just a fair-weather solution to the nation's healthcare ills. It's good news that Obama understands that healthcare costs are intimately tied to the economic health of American business, and that reforming the system cannot wait until the economy recovers. Universal coverage, properly designed, can do more for the nation's health than all the usual vain New Year's resolutions to stop eating cookies after lunch.

7. We hope for peace in the world. It will take more than a single year for the new president to undo the damage done to America's standing in the world by his predecessor's policies. But since governing is about putting first things first, there are some knots we would like to see undone in 2009. Most urgent is the need for renewed engagement in the Middle East, where a hot war has started in Gaza. The most promising areas may be North Korea's nuclear program and an American-brokered peace between Israel and Syria. At the same time, we would be cheered to see a dialogue opened with Iran, the lowering of tensions between Pakistan and India, and a fresh start for US-Russia relations. That would be a good year for the home team.

8. We hope Greater Boston's public institutions become better neighbors. Lately it seems that hospitals and universities are the only places around that are expanding. Increasingly, these tax-exempt stalwarts are city-builders, reshaping whole neighborhoods - architecturally and culturally - into new institutional zones. While no one doubts the value of education and healthcare, and the substantial employment opportunities that come with their success, we hope local colleges and medical centers will take a closer look at how their master plans line up with their charitable missions. That means Boston College thinks twice about forcing an unwelcome dormitory expansion plan into residential Brighton; Harvard continues close dialogue with community leaders as it builds its life sciences campus in Allston; and the great hospital network operated by Partners HealthCare recognizes the impact its muscular expansion into the suburbs is having on community hospitals.

9. We wish for a re-setting of national values. We don't want to romanticize hard economic times. The recession hurts real people's current lives and strangles their futures. But we are hoping for a corrective balance to the profligacy of the past decade, built on an unsustainable tower of national and personal debt. New Year's is traditionally a time for personal introspection. This year, more than most, it is fitting to redefine needs and wants, to nurture friendships, take solace from the arts or the natural world, and delight in what is right in front of us instead of grasping for what's out of reach. We hope that helps.

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A BOSTON GLOBE EDITORIAL
"High stakes in health battle"
January 9, 2009

THE KNOCKDOWN fight between Tufts Medical Center and Blue Cross Blue Shield of Massachusetts over the reimbursement rate for doctors at the hospital is Exhibit B of the dysfunction of the state's health insurance system. Exhibit A, of course, is the much better rate that Partners HealthCare muscled Blue Cross into granting to its teaching hospitals, Mass. General and Brigham and Women's, in 2000. Two sides of the same coin, these deals cry out for reform.

Doctors who meet quality standards while handling complex cases at academic centers should get uniform reimbursement - not just from private insurers but from Medicaid and Medicare as well. Reformed rates should also better reward primary care.

But comprehensive changes will have to await action by a payment reform commission that the Legislature called for last year. Lamentably, that panel has yet to meet. In the meantime, Tufts said Monday that talks with Blue Cross, the state's largest insurer, had reached a stalemate. Starting Feb. 1, Tufts doctors will no longer take part in the Blue Cross HMO plan.

This is a drastic step for a hospital to take, with an impact on patients. Also, with the recession cutting into employers' and workers' ability to afford insurance of any kind, Tufts's bid for a Blue Cross rate increase well above the rate of inflation could be seen as the last thing the state needs.

But Tufts CEO Ellen Zane makes a good case that her hospital, with rates lower than the two Partners hospitals and Beth Israel Deaconess, treats difficult cases more efficiently than the other three. If Blue Cross's current rates for Tufts, which Tufts says are 32 to 35 percent below rates for Partners, cause doctors to switch - with their patients - to the other hospitals, the overall cost to the system would also rise.

Not all insurers do as Blue Cross does. Zane argues that the state's second-largest insurer, Harvard Pilgrim, reimburses more fairly. Blue Cross pays Tufts below the average for teaching hospitals in Boston, she says, and not enough to cover her costs. Blue Cross denies that.

Blue Cross has said it is willing to pay Tufts more if the hospital would sign its new alternative quality contract, which bases a portion of payment on performance quality and not just fee for service. However, the insurer has not imposed such a condition on the higher rates it pays to doctors at Partners.

Performance-based contracts are still relatively new in this state, and might become more attractive to Tufts - and a major part of a reformed payment system - if they prove themselves in the future. Until then, Tufts deserves a better deal from Blue Cross. And the state deserves a better payment system than the current one - a monument to inequity and inefficiency.

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Photo by Sarah Kaempfe
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Ready to ‘make sacrifices’: Top New York Times and Boston Globe executives continue to rake in multimillion dollar salaries and perks as the company’s share price tanks and the Globe faces a closure threat.
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"Globe execs land millions while seeking major union cutbacks"
On top of the Globe, By Christine McConville, Wednesday, April 8, 2009, www.bostonherald.com - Media & Marketing

Top executives at the New York Times [NYT] Co. and The Boston Globe were awarded stock options potentially worth millions just weeks before they told the Globe’s unions to cut $20 million or face closure, according to regulatory filings.

As Globe workers braced for another round of newsroom cuts in late February, the beleaguered broadsheet’s publisher P. Steven Ainsley, who made $1.9 million in 2008, was awarded options to buy 90,000 shares at $3.625 each. The options vest over three years and would include an additional cash payout in 2012.

Times CEO Janet Robinson and Chairman Arthur Sulzberger Jr. each were awarded 500,000 stock options at $3.625 plus a cash payout equal to 50,000 shares in 2012.

The only way the executives won’t get big payoffs is if Times share prices drop below $3.625 - just off their historic low - and stay there. For example, if the options vested yesterday, when the stock closed at $4.83, Robinson and Sulzberger would get $600,000 from their options and Ainsley’s would be worth $108,000.

The stock option awards come on top of Robinson’s total 2008 compensation of $5.6 million and Sulzberger’s $2.4 million in 2008 pay. The pay includes $38,000 and $35,000 bonuses, respectively, in a year when share prices dropped 60 percent.

“That’s disgusting,” said one Globe staffer, who spoke on condition of anonymity.

The Times Co. is seeking pay cuts, the elimination of lifetime job guarantees for hundreds of workers and reduced pension and health-care contributions.

In a memo to Globe employees this week, Ainsley said that, to survive, the paper “will need significant concessions from labor.”

Ainsley, who received $247,896 in relocation expenses to move from Tampa, Fla., to a $2.4 million Wellesley manse in 2006, also said in the memo: “It is only fair that management also be prepared to make sacrifices.”

Despite Times Co.’s 60 percent share price drop in 2008, which has continued this year, the company continues to dole out multimillion-dollar executive salaries, bonus awards and perks.

Last year, the company paid former International Herald Tribune Publisher Michael Golden $106,461 to relocate from Paris to Manhattan. That relocation fee is in addition to the $1.6 million that Golden, a member of the family that owns the Times, was paid in 2008.

In his memo to Globe employees, Ainsley said the company, which the Herald learned is raising newsstand rates next month, has “a strategy in motion which will bring in additional revenue from consumers and advertisers.”

Edward Atorino, a media analyst with Benchmark Company, said he’s sure the Times will try all sorts of new concepts.

“I’m sure they are rolling out everything they can,” he said.

But financial analyst Douglas McIntyre, editor of the blog 24/7 Wall Street, scoffed at that.

“If they had these kinds of miracle cures, why are they still having problems?” he asked.

To McIntyre, it sounds like the company is saying “whatever it can, to coax as many concessions as possible out of the unions.”

“Their interest is in getting the union to drop all the provisions in its contracts, because then they can operate the paper at will, which they can’t do now,” he said.

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A BOSTON GLOBE EDITORIAL
"A public plan for healthcare"
May 3, 2009

THE SUCCESS of Massachusetts' three-year-old experiment with universal health insurance has made it a focus of attention as Congress and the Obama administration weigh reform on a national scale. But Massachusetts isn't a model for everything. A case in point: the debate over whether national legislation should include a public insurance plan as an option for consumers who don't qualify for Medicare and Medicaid and cannot get coverage through employers.

The architects of reform in Massachusetts opted not to create such a public plan, and opponents of the idea, such as private insurance companies, make much of that decision. Private insurers fear that a public plan would use its bargaining heft to drive down costs and grab a disproportionate share of the market. Advocates of a public plan, such as President Obama, say it is the best way to ensure affordable coverage and to provide a yardstick for the private plans.

So, does the Massachusetts example clinch the case against a public plan? No.

As noted by speakers at a conference recently at Harvard's Kennedy School, this state could avoid a public option because it already had a highly regulated insurance system that ruled out some of the more unsavory features of laissez-faire private insurance. Companies in Massachusetts could not refuse customers because of preexisting conditions or reject policy renewals after health problems emerge. Insurers could charge higher premiums based on a customer's age or place of residence, but not health history.

The state required that insurers cover many treatments and procedures, such as special screening of newborns, beyond the bare-bones policies offered elsewhere. It had a relatively low number of uninsured residents to start with. And, almost alone among the states, Massachusetts had no for-profit firms among its major insurers.

With a national health reform debate looming, some major private insurers have said they could live with a requirement that they accept all patients if it is paired with an individual mandate, like the one in Massachusetts. This would ensure that the young and healthy join the risk pool and lower its overall costs. But the Massachusetts rules would hamstring the private insurers that specialize in excluding anyone with a preexisting condition and providing as little care as possible to everyone else.

As the debate in Washington swirls over creation of a public plan, its supporters should not be cowed into dropping their insistence on it. Massachusetts is getting along without a public plan, but the national health insurance market is vastly different.

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A BOSTON GLOBE EDITORIAL
"Mass. bashers take note: Health reform is working"
August 5, 2009

PUNDITS and politicians who oppose universal healthcare for the nation have a new straw man to kick around - the Massachusetts reform plan that covers more than 97 percent of the state’s residents. In the myth that these critics have manufactured, this state’s plan is bleeding taxpayers dry, creating nothing less than a medical Big Dig.

The facts - according to the Massachusetts Taxpayers Foundation - are quite different. Its report this spring put the cost to the state taxpayer at about $88 million a year, less than four-tenths of 1 percent of the state budget of $27 billion. Yes, the state recently had to cut benefits for legal immigrants, and safety-net hospital Boston Medical Center has sued for higher state aid. But that is because the recession has cut state revenues, not because universal healthcare is a boondoggle. The main reason costs to the state have been well within expectations? More than half of all the previously uninsured got coverage by buying into their employers’ plans, not by opting for one of the state-subsidized plans.

This should be exciting news for those fiscal conservatives, including both Republicans and “blue dog’’ Democrats, who claim to support the goal of universal coverage while despairing over its budget impact. But that’s not what you hear from the Massachusetts bashers. Trying to scare off the nation from helping the uninsured get coverage, Fox News host Bill O’Reilly said recently, “You don’t have to look any further than the universal healthcare mess in Massachusetts to see disaster ahead.’’ New York Times columnist Ross Douthat on Monday accused President Obama of “pushing a health plan that looks a lot like the system currently hemorrhaging money in Massachusetts.’’

The Republican governor of Minnesota, Tim Pawlenty, has also gotten his licks in. Costs in Massachusetts, he wrote in the Washington Post Monday, “have been dramatically higher than expected.’’ Pawlenty’s purpose in attacking this state’s plan might be both to discredit a national plan and to score points against former governor Mitt Romney, one of the architects of what Massachusetts has accomplished. Romney, of course, is a possible rival of Pawlenty for the GOP presidential nomination in 2012.

Whether out of ignorance or convenience, all three bashers have it wrong. Unlike the Big Dig, health reform came in on time and under budget. It will be proportionately more expensive nationally to provide coverage for the uninsured than it has been here simply because the state began the task with a much lower rate of uninsured, 7 percent, compared with the US rate of 17 percent. But a national plan that relies, as Massachusetts’ does, on both government-subsidized insurance and a mandate on employers to offer insurance or pay a penalty (in Massachusetts’ case, a very small penalty) should be able to cover nearly everyone without busting the budget.

In Massachusetts, cost estimates for the reform plan before its passage in 2006 were so low that Romney and the reform law’s Democratic supporters in the Legislature were able to get away without creating a new tax to fund it. After the costly Wall Street bailout and the $787 billion stimulus package, that option is not open to President Obama and Congress. But Congress should not allow itself to be buffaloed by false claims about Massachusetts into fearing a tsunami of red ink.

There is one other statistic about the Massachusetts plan that politicians, in particular, should appreciate. According to Robert Blendon of the Harvard School of Public Health and the Kennedy School of Government, the law’s approval rating in June 2008 was 69 percent. That is a figure officeholders can only dream about.

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March 16, 2018

Re: Romney-care’s flaws

Romney-care was a flawed program that relied on short-term goals to promote then Governor Mitt Romney’s political ambitions to be elected U.S. President. It was not universal heath-care, single-payer insurance. It had no state government-funding source. It relied largely on two sources: federal funds, and the state's free-care pool, which used to pay for charity care at hospitals and health centers. It required a medicaid waiver from the federal government. Increases in premiums and deductibles, and the like, priced many needy working people out of the health insurance market. Those priced out of the market cost more money in the long-term due to their chronic illnesses! It was like an added tax on small businesses as cost grew without cost controls. It had tax penalties on the hard-hit working class who remained uninsured or under-insured. It was written by a conservative think-tank named the Heritage Foundation. It primarily benefited a handful of state and national insurance companies (see below).

5 Massachusetts insurers control about 90 percent of the healthcare insurance market in the Commonwealth of Massachusetts:
#1 - Blue Cross Blue Shield
#2 - Harvard Pilgrim Health Care
#3 - Fallon Community Health Plan
#4 - Health New England
#5 - Tufts Health Plan
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There are also national healthcare insurance companies such as United HealthCare Insurance Co., Aetna, and CIGNA.

As for Romney-care used as a template for Obama-care, the latter had many of the same flaws as the former program. No one in U.S. Congress read the excessively lengthy bill that not one Republican delegate voted for. Obama-care was a sell-out to insurance and pharmaceutical corporations, and it was written by their highly-paid lobbyists. It did not control for costs, and broke its own promises of affordable care for the hard-hit working class. Unlike Romney-care, Obama-care eliminated the pre-existing condition policy that hurt people with chronic and disabling health conditions, and had other reforms such as keeping children on their parents’ health insurance plan through 26-years of age.

I do not support either Romney-care or Obama-care! I support a universal, single-payer health insurance program or Medicare for All program. Every other country has a public option with cost-controls except our own country. Health insurance should not be about politicians like Romney or Obama. It should not be about benefiting insurance companies and pharmaceutical firms instead of the people. Healthcare insurance is a Human Right!

- Jonathan Melle

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April 7, 2018

Re: Eagle on education

The Berkshire Eagle’s editors point out the problems with the commonwealth’s 25-year-old education funding formula. I agree with their assessments on poor communities being treated inequitably by their state government in Massachusetts.

I remember the “Big Dig” from 25 years ago. The “Big Dig’s” recurring billion dollar cost overruns were a real warning to cities, towns, counties, and public school districts constrained budgets back in the 1990’s. Despite the red flags of Boston’s “Big Dig”, Beacon Hill kept on with its pork barrel project. It was only a matter of time, which has come, that the “Big Dig” would suck away like a black hole the money needed for local budgets’ fiscal solvency.

Then, I remember when Willard Mitt Romney became Governor of Massachusetts in 2003, or 15 years ago. One of the first things Romney did was make deep cuts to local government, including public education! 2002 was a deep economic recession. At that time, it was the worst recession since the Great Depression of the 1930’s.

Ironically, I remember then-Governor Romney gave the Legislature a pay raise to buy their support. Romney was such a flop that he served only one term as Governor. He would spend the next decade running for U.S. President without success. Now, Romney is running for U.S. Senator from Utah.

Over the past 25 years, Massachusetts endured the “Big Dig”, and two major recessions in 2002 and 2008. Massachusetts is the number 1 per capita debtor state in the nation. Massachusetts is ran by a one political party oligarchy that only serves the vested and special interests. The common citizen has no real voice in Massachusetts politics!

In conclusion, Massachusetts’ fiscal mismanagement, compounded by the “Big Dig” and 2 major economic recessions, left local government and poor communities without equitable economic supports. The wealthy suburbs and corporate interests have been able to stay afloat, while the poor and constrained communities are being pushed closer to the proverbial cliff!

- Jonathan Melle

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“What your paycheck can expect from Paid Family and Medical Leave Act kicking in”
By Kristin Palpini, The Berkshire Eagle, May 20, 2019

Pittsfield — Come July, employees across the state will begin to notice a dip in their paychecks.

That's because the first phase of the Massachusetts Paid Family and Medical Leave Act will kick in.

On July 1, the state will start taking deductions from the paychecks of employees at all private companies to fund the program. The law will be fully implemented in 2021.

With formal state guidance on how to implement the program not anticipated until after its launch in July, Berkshire business owners and tax professionals gathered Monday morning at Pittsfield City Hall for a presentation on the legislation, organized by 1Berkshire. Additional sessions have been scheduled later this week in North Adams and Stockbridge.

Benjamin Knox Steffans, a lawyer for employment law firm Steffans Legal, answered questions and addressed the ins and outs of the new act.

"A lot of people are concerned because [with] any financial regulations like this, people want to know how they can do it and where things go," said Katie Dobson, a certified public accountant with Smith, Watson and Company. "I'm trying to learn as much as I can because this is about to start."

The act is designed to improve upon the federal Family and Medical Leave Act, which is unpaid. When the law takes full effect in 2021, employees will be able to apply for 12 to 26 weeks of paid time off.

But exactly how much employees are charged will vary depending on the size of the company and other factors.

For companies with 25 or more employees, the business will be responsible for paying at least 60 percent of an employee's medical leave contribution. Businesses with fewer than 25 can pass on the total cost of the contribution to individual employees, but the state has cut a break for employees in this situation. They will pay a reduced deduction that amounts to 60 percent off their medical contributions.

Companies could, however, decide to pay for more of the contribution or the whole amount for employees. Some employers are debating whether taking the financial hit to spare employees the cost is worth the morale boost, while others aren't sure how they're going to come up with the minimum payment.

"Employees are sick of being nickel and dimed — it's just one more thing," said Randy Porter, executive director of PTPN in Pittsfield, who is considering how much to cover for employees.

On an individual scale, the cost of the act is relatively small compared to what employees will pay.

Starting July 1, qualifying employees will begin contributing to the statewide fund. The contribution is 0.63 percent of an employees gross wages and is made up of 0.52 for medical and 0.11 for family leave.

"I don't think there's going to be a lot of tension around this," Steffans said. "I think people are going to realize they're paying for something that's paid leave, that's good for them."

An individual employee earning an annual salary of $50,000 at a company with more than 25 employees will be required to pay $315 into the fund each year. The employer's share of the contribution will be at least $156 while the employee would cover the remaining $159, according to a PFML calculator provided on the Massachusetts state website.

But hundreds of dollars per employee could easily stack up to a new multithousand-dollar bill for an individual company.

A company with 50 employees — 25 using W2 tax forms and 25 using the 1099-MISC tax form for contractors — and an annual payroll of about $1.88 million would be assessed an $11,812 contribution to the program for the year. At least $5,850 of the total would be paid by the employer and $5,962 would be covered by staff.

"I definitely have more questions," Porter said following the meeting. "I feel bad for the payroll companies; they're going to have to deal with this."

While Massachusetts people will begin contributing to the new paid medical leave fund in July, the benefit won't be available until Jan. 1, 2021. Covered individuals — people who live and work in Massachusetts — will be entitled to take up to 12 weeks of paid family leave in a year related to birth, adoption or foster care placement; up to 20 weeks of medical leave to recover from a serious health condition and up to 26 weeks to care for an ill family member.

Weekly benefits will be determined by a person's earnings, but won't exceed $850 per week.

To be eligible for paid leave an employee must have about 15 weeks or more of earnings and have earned at least $4,700 in the 12-month period.

One of the most persistent questions asked during Monday's presentation was: How do contractors fit into the new act?

Employers will have to collect contributions from individual contractors who are not affiliated with another company if they make up 50 percent or more of a business's total workforce.

The number of employees a company has will be determined by deducing the business's average monthly employment. This calculation is expected to help firms that hire seasonal, or otherwise have staffing fluctuations, to arrive at a total employment tally. All employees are counted: part-time, full-time, contracted, seasonal, unionized, etc.

Steffans said business owners should keep tabs on development of the act over the next several years as the state is likely to tweak regulations.

"It's a lot of leave," Steffans said. "It's capped at 26 weeks in a calendar year. The state is writing regulations and it's being revised, but I don't think the core [of the act] will be changed."

Kristin Palpini can be reached at kpalpini@berkshireeagle.com, @kristinpalpini.

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