Saturday, May 28, 2011

Rate Review vs. the Legislature

One thing worth pointing out is the open and democratic nature of the provider pricing regulatory process in MA.  Hospitals will push back and rightly so, whatever doctrine emerges will need their support and consent.  The right way to get at that is through a legislative process.  That may be slow, cumbersome and prone to unwieldy compromises but so is life.

In contrast certain people in Oregon have pushed to twist premium rate reviews into the be-all end-all of healthcare reform.  Rate review is a poor forum for the task, it is dominated by technical calculations that few people understand and has no apparatus or experience with assimilating input from all the interests involved.  With limited input you are more prone to get unintended consequences. 

Case in point, the call to subsidize individual policies at the expense of large group plans.  That would in effect penalize companies who offered health coverage to the benefit of those who did not.  Obviously, it would encourage companies to drop employee coverage which goes against the stated objectives of reform advocates never mind the politics.  It’s an absurd policy on it’s face that would likely not make it out of committee in the legislature.  Rate review on the other hand is basically at the discretion of DCBS.  It merely takes an ambitious Director to put such an ill-conceived policy into practice.

It makes you wonder, why are reformers so reliant on demagoguery?  If it’s good policy bring it through the legislature, make a case for it and make it law.  The back door stuff demeans us all.

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