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The Holy Grail of health care savings

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For years, those trying to control health care costs have placed private and public attempts on par with the little Dutch boy who put his finger in the dike to plug a hole. We never have enough fingers to stem the flood. But maybe we’ve been looking at it wrong.

Perhaps the better metaphor is the scene from Monty Python’s Life of Brian where the mob takes off after an unwitting and unwilling messiah to try to discern what his message is. Follow the holy gourd? The meaning of the shoe? Personal mandate? Free market?

The answer is. . . apparently, no one knows. Retiring US Rep. Barney Frank, now free to speak his mind – not that he ever really put a hold on it – says President Obama erred in pushing the health care reform before tackling the economy as a whole. Frank’s underlying message was the reform was far too big and the problems too multifarious to expend so much political muscle on.

“The problem with health care is this: Health care is enormously important to people,” Frank, a longtime supporter of universal health care, told New York magazine. “When you tell them that you’re going to extend health care to people who don’t now have it, they don’t see how you can do that without hurting them.”

As everyone with two ears knows, health care will be among the most dominant issues in the upcoming year, not that it’s ever been in the shadows. The Supreme Court is due in the next couple months to rule on the constitutionality of the federal health care law. Even if it is upheld, an iffy proposition, with Mitt Romney promising to repeal Obama’s reform on Day 1 and Sen. Scott Brown and his opponent, Elizabeth Warren, on each side of the divide, the cacophony will not cease.

In New York, then-Attorney General Andrew Cuomo reached a settlement with private insurers to set up a database with objective pricing of doctors’ fees that patients around the country could rely on when seeking out-of-network coverage. But after spending $95 million to create the database as mandated by the settlement, many insurers ignored their own site and, instead, began reimbursing physicians at dramatically lower Medicare levels, costing consumers thousands of additional dollars in out-of-pocket expenses.

The insurers were required to compile billions of bills to aggregate information for the database but nothing said they had to abide by it. Free market, you see. But what it does not address is the single biggest argument for health care reform: Medicare taxes are paid by everyone; private insurance is still optional, more or less.

Globe columnist Yvonne Abraham today relates the story of a Massachusetts employer trying to do the right thing by offering insurance to his workers. The problem is, he cannot get 25 percent of his employees to sign up and that means despite his efforts, he’s paying the fine for not having his workers in the pool. A mandate, Abraham argues, would make it cheaper and more attractive for everyone.

The Massachusetts Senate is about to release Gov. Deval Patrick’s payment reform bill, which it has held up for more than a year. But Sen. Richard Moore, who co-chaired the committee studying it, says it will undergo “a significant redraft,” but did not give any details. A report released today by MIT economist Jonathan Gruber – and funded by Blue Cross Blue Shield of Massachusetts – says even modest payment reform could produce savings for the state’s employers and, in turn, their workers, of $8 billion over the next nine years. More aggressive reform could boost those savings to as high as $34.5 billion in the same time frame, about $1,000 per worker.

Does this seem to be all over the map? Well, it is because that’s the problem. Our advice: Follow the gourd.

                                                                                                                                --JACK SULLIVAN



BEACON HILL

The House passes the 2013 budget in three relatively debate-free days.

Former state treasurer Tim Cahill has a new lawyer, and the lawyer says his client did nothing wrong when he aired Lottery ads while he was running for governor, AP reports (via WBUR). Cahill’s lawyer compares the Lottery ads to signs in which Gov. Deval Patrick welcomes border-crossing visitors.

Gaming Commissioner Stephen Crosby explains the casino opening timetable.  Patrick says no dice to the Wampanoag Tribe of Aquinnah.

MUNICIPAL MATTERS

Lynn firefighters battle blaze at an abandoned home, the third such fire in four months, sparking fears of a pattern, the Lynn Item reports.

Replacing old water lines in Gloucester could cost $100 million, part of aging water infrastructure costs across the state that could top $10 billion over the next 20 years, the Gloucester Times reports.

SECOND AMENDMENT

A Brockton Superior Court judge ordered a permanent injunction banning pistol and rifle shooting at a Scituate gun club after stray bullets struck nearby homes.

NATIONAL POLITICS/WASHINGTON

State and local governments increasingly are hiring social media directors, Government Technology reports (via Governing).

ELECTION 2012

Keller@Large takes note that the Brown-Warren race is about class warfare. Meanwhile, Elizabeth Warren holds to a Roxbury town meeting-style event but doesn’t take questions, raising more questions as a result.

Two veteran Democrats are ousted in Pennsylvania primary, the AP reports (via Governing). The lawmakers had opposed the sweeping health care overhaul, and their ouster will likely deepen the polarization of Congress, the New York Times says.

Republicans want Mitt Romney to stand for something.

Gail Collins buries the GOP primaries.

FISHING

Sen. John Kerry has succeeded in getting language inserted into the upcoming appropriations bill to increase funding for fisheries research.

BUSINESS/ECONOMY

Citizens Bank agrees to a $137.5 million settlement related to questionable overdraft fees and manipulation of debit card and ATM transactions.

A Salem high-tech manufacturer helps pay for renovations to a nearby day care center to allow it to stay in the area, the Salem News reports.

EDUCATION

There is plenty of gnashing of teeth over student loans, but Pell grants are also threatened.

Senate candidate Elizabeth Warren’s support for freezing student loan interest rates runs counter to views she put forward in a 2003 book in which she faulted government aid programs for helping drive up the cost of higher education, the Globe reports.

The Falmouth-based National Graduate School of Quality Management turns out to be the national poster child for higher ed management greed and excess.  

TRANSPORTATION

The Berkshire Eagle wants federal and state officials to mediate a dispute that has sidelined the Berkshire Scenic Railway, which runs a tourist route between Lenox and Stockbridge

ENERGY/ENVIRONMENT

The town of Concord passes a bottled water ban, NECN reports.

A top administrator at the Nuclear Regulatory Commission has recommended approval for renewing the Pilgrim power plant license, which expires June 8.

CRIMINAL JUSTICE

Anthony DiNunzio, the reputed big cheese of what’s left of the New England mob -- and younger brother of the jailed mobster known as The Cheese Man -- was arrested yesterday and charged with racketeering and extortion. Meanwhile, the Herald runs with this headline.

Mark Rivera, a close friend of former Lawrence school superintendent Wilfredo Laboy, pleads guilty to larceny, the Eagle-Tribune reports. Laboy was jailed on fraud and embezzlement charges a month ago.

Bristol Sheriff Thomas Hodgson vowed to place a statewide referendum before voters for approval of a $5 a day fee on inmates after the House rejected it in the budget debate.

SPORTS

B-ruined. But at least Tim Thomas won’t have to turn down an invitation to the White House again.

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