BMC chief backs Medicaid for all

Says Medicare for all is little more than a slogan

KATE WALSH says she favors Medicaid for all, not Medicare for all.

It’s not a political slogan you hear much these days, but Walsh, the president and CEO of Boston Medical Center, has a unique perspective since so many of her hospital’s patients are on Medicaid.

“I actually think Medicaid is the most important insurance plan in the country,” she said, noting that it covers roughly 79 million mostly poor and elderly Americans and provides them with coverage for long-term care, medicine, behavioral health, and substance abuse. Every state offers Medicaid, so there is opportunity for local customization of insurance offerings.

“Why I’m a Medicaid for all person is it’s a public option that works for the public,” she said.” I think Medicare for all is a much better political slogan and I’m afraid it’s just that.”

On the Health or Consequences Codcast with John McDonough of the T.H. Chan School of Public Health at Harvard University and Paul A. Hattis of Tufts University Medical School, Walsh said the issue that keeps her up at night is “the dissatisfaction most Americans have with our health care system.”

She said the decision by MassHealth, the Massachusetts Medicaid program, to shift hundreds of thousands of patients into 17 accountable care organizations is the right strategy. Boston Medical Center is a key player in the ACO movement, which incentivizes health care systems to live within a budget as they provide total care for patients.

“We are on the right pathway here by basically aligning the incentives between the people taking care of the patients and the people who are paying for it,” Walsh said. “But we’re up against poverty. Getting a low income population healthy is really a big job. It’s a challenge.”

Walsh agreed that there is no plan B. “We have to get this right because, if we don’t, healthcare costs are going to continue to go up and then we’ll be faced with choices we don’t want to make about how we take care of the patients we serve. I guess, to quote Apollo 13, failure is not an option here. We have to make it work.”

Hattis asked Walsh what she thought about some preliminary research findings released recently by the Health Policy Commission suggesting many hospitals are inflating the severity of patient diagnoses to secure higher insurance payments.

Walsh was skeptical, suggesting a key factor in the increase in patient diagnoses severity may be the rise in out-patient treatment (which means the remaining patients in hospitals would be facing more serious illnesses) and questioning the proxy the commission used to suggest actual illness severity has not increased.

Hattis recently wrote his own analysis on the issue, and reached a different conclusion. “It seems much more like gaming of the system,” he said.