Medical Experts Weigh In on Mass. Health Plan

Farai Chideya dissects Massachusetts' sweeping new health care plan with Dr. Howard Koh, former health commissioner of the state and now a professor at the Harvard School of Public Health. Also joining the conversation is Dr. Ivan Walks, a former Washington, D.C., chief health officer who's now head of Ivan Walks and Associates, a consulting firm specializing in public healthcare policy.

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FARAI CHIDEYA, host:

While Massachusetts is the first state in the country to approve such a comprehensive plan, it raises one big question: what's next? How likely are other states to follow suit, and could this legislation become a model for ensuring that more Americans can get the care they need?

We're joined now by Dr. Howard Koh, former Massachusetts Health Commissioner, and now a professor at the Harvard School of Public Health. Also on the line, Dr. Ivan Walks, former Washington D.C. Chief Health Officer and now head of his own consulting firm, Ivan Walks and Associates.

Good to have you both on the program.

Dr. HOWARD KOH (Former Massachusetts Health Commissioner): Thank you.

Dr. IVAN WALKS (Former Chief Health Officer, Washington, D.C.): Glad to be here, thank you.

CHIDEYA: Dr. Koh, let's start with you. Given your experience as former health commissioner of Massachusetts, what do you see as the significant benefits of this legislation, and any drawbacks?

Dr. KOH: Well, as a former state health commissioner and as a physician, I know too well what happens when people have no health insurance. Their treatment is often delayed or even denied, and that's a tragedy not only for the individual, but for all of us as a caring society.

So what we have here in Massachusetts now is something that is groundbreaking and historic, but also untested. It's filled with promise but also with risk. We have an incredible feeling of hope here that we can provide insurance to almost all who are currently uninsured, and hopefully solve one of the most challenging public health issues of our time.

CHIDEYA: Dr. Walks, do you think that this program could be a model for other states in the country, for Washington D.C., where you served as former chief medical officer? Why or why not?

Dr. WALKS: I think this can be an excellent model. When I was in Washington D.C., we also redirected funds from what you call uncompensated care as Massachusetts is planning to do, and put it into something called the Healthcare Alliance, so that anyone who was without insurance, lived in the district below the federal poverty, line could have insurance coverage and have full coverage.

I think that two opportunities in Massachusetts is one, by putting everyone into an insurance situation. You don't have the uninsured problem. And the other thing that I think is critical that's happening in Massachusetts, a lot of the checks and balances that we need in healthcare, for example, holding folks accountable for outcomes, tying increases in reimbursement to the kinds of outcomes that we want, those are the kinds of things that healthcare has to do in order to become more efficient.

CHIDEYA: Dr. Koh, we heard in the piece that Rachel Gottbaum did that the concept of what is affordable may vary from person to person. A family was profiled--they thought that paying $900 plus dollars a month was unworkable. Another family may have tightened their budget and paid that. So, what does affordable mean? What should affordable mean, and how are politicians going to judge that?

Dr. KOH: Well, that's an excellent question, and there are so many questions that need to be resolved about implementation of this historic law. And so, exactly what is affordable has yet to be determined by the state, and a new state agency called the Connector is being established to help put forward those guidelines and to provide the adequate levels of subsidies.

The overall goal however, as you have pointed out, is to provide health insurance to those who do not have it now. These are people who are the working poor. They have jobs. They're paying taxes. They earn too much to qualify for Medicaid, although Medicaid expansion is now a part of this new law.

And there will be tremendous debate about how to resolve that issue about what is affordable, with the overall goal of reaching coverage for just about everybody.

CHIDEYA: And Dr. Koh, you worked on prevention issues when you were working in your public health for the Massachusetts state role. How much does lack of care cost a state like Massachusetts or a nation--people who just don't go to the doctor until they're seriously ill?

Dr. KOH: Another great question. People without insurance will delay seeing a doctor, if they have a doctor at all. They'll let conditions, treatable conditions like heart disease, cancer, and diabetes worsen before seeking care. Or they will try to get their primary care in overcrowded emergency rooms.

And what's most tragic from a public health point of view is that people will not receive good preventative care for simple things like blood pressure checks or mammography, because they don't have access to healthcare and the insurance to see somebody to get such services. So, we are hoping that this new law and this new development here in our state will help save lives and promote the power of prevention.

CHIDEYA: Dr. Walks, again, in your role in Washington, D.C., it has a very different government structure than any state. It's a district, not a state. It has a lot of poverty, a lot of public health issues. In states that may be less wealthy than Massachusetts, or in the District of Columbia, where would the political will come from to try to create a plan like this one?

Dr. WALKS: Well, I think that what you have to do is look really in detail at what Massachusetts is doing, and it isn't only giving everyone insurance. This connector entity that Dr. Koh mentioned is a critical component, because that connector entity will also function to look at what's good and what's appropriate, and how care should be delivered. And so, when you begin to look at the quality of healthcare and the effectiveness of healthcare delivery systems, then cost really is not an issue, because the most effective healthcare is early and appropriate healthcare. It's the most cost-effective way to go.

So I think other states that are less wealthy need to look at how much money is actually being spent? Now, D.C. may not be a state, but it does have a state Medicaid program, so those same kinds of Medicaid waivers and Medicaid opportunities are available for folks to look at. I think the Massachusetts model is an excellent one for folks to look at across the country, but don't forget the key points of efficiency that are going to be looked at--quality, as well as health disparities that are all part of this groundbreaking Massachusetts law.

CHIDEYA: Well, we're going to have to leave it there, gentlemen. We've been speaking with Dr. Ivan Walks. He's the former Washington, D.C. chief health officer, and now head of his own consulting firm, Ivan Walks and Associates. Also, Dr. Howard Koh, former Massachusetts health commissioner, now a professor at the Harvard School of Public Health. And we will be keeping a close eye on the issue of universal coverage, and also on Governor Mitt Romney as he enters, possibly, the 2008 presidential race.

Thank you gentlemen, so much.

Dr. KOH: Thank you, Farai.

Dr. WALKS: Thank you.

CHIDEYA: Coming up next, Bill Clinton regrets his failure to heal the racial divide. And, one college puts together an academic program for black men only. Those topics next, on our roundtable. Plus, remembering the late June Pointer of the Pointer Sisters.

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