DR. ERIC DICKSON, the CEO of UMass Memorial Health Care and the chair of the board of the Massachusetts Health and Hospital Association, says the health care inequities that have surfaced during the coronavirus pandemic can be addressed through policies that help hospitals like his that cater to some of the poorest people in the state.
On The Codcast with John McDonough of the T.H. Chan School of Public Health at Harvard and Paul Hattis, formerly of Tufts University Medical School, Dickson outlined three key policies to improve health care equity – stop the expansion of Mass General Brigham into Westborough, Westwood, and Woburn; raise Medicaid payment rates; and make Medicare available to more people by steadily lowering the age of eligibility.
All three policies center around the way hospital care is paid for, with Medicaid, the government insurance program for the poor and elderly, paying lower rates than commercial health insurers. The disparity in payment rates means hospitals that cater to the poor rely more on Medicaid funding and can only survive if they are cross-subsidized by higher payments from commercial insurers.
As it is, UMass Memorial is just breaking even, Dickson said. “We can keep the lights on but having dollars to invest in new buildings and technologies, that comes really hard to us,” he said.
Dickson said Mass General Brigham’s plan to open ambulatory care centers in Westborough, Westwood, and Woburn threatens that financial balancing act. He is urging the Department of Public Health to block those expansion plans, fearing that Mass General Brigham will cherry-pick commercial insurance customers in those communities, taking money away from hospitals like his that rely on that funding.
“If you let the most expensive, largest health care system in the state expand to one of the wealthiest regions of the state and neighborhoods of the state, we just all have to go in eyes wide open and say, boy, that’s going to have a negative effect on the health care systems that were cross-subsidizing their care before, and in Westborough that’s us,” Dickson said.
Dickson also wants to see Medicaid rates increased, and he says the best way to do that is to impose a tax on health providers that care for a greater percentage of patients with commercial insurance. The tax revenue could be used to buttress Medicaid rates, which health care providers that cater to the poor rely on.
The financial impact on the state would be minimized because Medicaid costs are split between the state and federal government, so a large chunk of the increase would be paid for by the federal government. “You can get there with almost no impact on state coffers,” Dickson said.
Dickson is a fan of Medicare for All, a single-payer health care system. He believes Medicare for All would do away with the complex gyrations health care systems go through to survive today and wring a lot of waste and inefficiency out of the system. He said businesses might see their health care costs drop 20 percent.
But he also recognizes that, politically, Medicare for All is a big political lift. So he is recommending that the nation move slowly toward that goal by reducing the age of eligibility for Medicare over time, allowing the system to adapt gradually. Without action, he says, the system will not survive.
“It is unsustainable. Something is going to happen,” he said. “And then you start to talk about equity. Can we really feel comfortable living in a society where women of color are getting mammography at a rate half that of Caucasian women? Getting diagnosed for cancer later because they don’t have the basic health care? … You want to be a part of that society?”