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Here And Sphere: Health Care Costs And The Nurses Strike

Jul 19, 2017 05:45AM ● Published by Mike Freedberg

Striking Tufts nurses : no matter which side is right, containing health care costs is the biggest challenge facing state governance reformers, including Governor Baker

We have seen, this past week, plenty of strife and controversy in the matter of the strike by Tufts Medical Center’s nurses. The hospital has brought in replacement nurses, a sit must; patients’ health problems do not go on strike, and that being the case, without replacement nurses, Tufts Medical Center would have to shut down rather than offer inadequate care to the very sick. It is always a risky thing for an employer whose wage employees strike to hire replacements, and just because Tufts is a hospital does not insulate it from the picket line consequences. If the reports that I have read are true, those consequenecs have been the usual : verbal abuse, even the threat of violence (both of which the striking nurses deny have happened). The strike continues, and so does the hiring of substitute nurses.

I begin this column with the Tufts situation because it arises — so the reports narrate in much detail — from the pressure that surging health care costs have applied to medical institutions. These are well known to policy makers : the rising cost of drugs, much of it attributable to the increasing difficulties in research; an even larger increase in the price of medical equipment, caused by their increasing intricacy; longer hospital stays and more expensive treatment, because more people are living much longer, and people older than 70 experience more diseases and system failures than those younger; the inability of many medical institutions to adopt the most cost-efficient records keeping means; and the expansion of medical administration resulting from the takeover of health care costs by the insurance industry.

Last year, Governor Baker decided that he could no longer defer the daunting challenge of proctoring our state’s health costs, which (in the upcoming year) amount to more than 40 percent of its $ 40 billion figure. The plan that he came up with surprised me, as it asked employers to contribute up to $ 300 million toward Massachusetts’s $ 16.6 billion Medicaid allotment. In June Baker offered a compromise, which you can read at this link : http://www.wbur.org/commonhealth/2017/06/20/health-care-costs-baker-employers

Baker’s compromise proposal did not survive the legislature’s FY 2018 budget vote, but others of his health care cost containments did make it. You can read the update here https://www.boston.com/news/politics/2017/07/07/massachusetts-lawmakers-approve-compromise-40-2-billion-state-budget

Such has been the first legislative response to the package of changes to our health care budget that Baker proposed on July 1st. The Boston Globe editorialized more or less favorably to9 the baker proposal, as you can read here : https://www.bostonglobe.com/opinion/editorials/2017/06/30/decoding-baker-mass-medicaid-changes/qnWg7cjtRpoD0fek1YrXEP/story.html

As the Globe editorial said, the task facing the legislature and governor is not easy or quick. 40 percent of the state’s budget can’t be reshaped that fast. Apportioning health care invoices is only the surface problem. The real difficulty rests in those invoices themselves. I itemized most of these above. Many of them can’t be solved by one state only; a few can’t be solved at all, only accommodated: especially, the consequences of more people living much longer affect every part of health care’s invoices. Disciplining these costs will only take effect once medical science learns how to manage aging itself. That day is surely coming, as we grasp the genetic codes that supervise aging. And even such supervision may not be enough. If people become able to live to age 110 and even beyond, they will face disorders whose dimensions — and treatment thereof — we can’t begin to compute.

Yet who of us would prefer health care to retreat from its advance ? Not most of us.

Now back to the Tufts Medical Center situation. Reports suggest that Tufts is falling behind rival medical centers for two reasons : first, it lacks the price negotiating clout of larger medical institution; second, its revenues aren’t growing fast enough. Tufts advances these factors as reasons for its refusal to meet the nurses’ wage and benefits demands. The nurses assert that Tufts can in fact afford the benefits changes it seeks.

Which side is right, I cannot tell, as I have not seen the Tufts Medical Center’s FY 2017 accounts. Yet surely the Tufts impasse will not be a one time only occurrence if health care costs continue to grow faster than the economy. Only one course might resolve this blockade: single payer health care, in which the entirety of health care invoices becomes a charge on the Federal budget — in other words, Medicare and Medicaid for all. Can single payer do the trick ? Perhaps, yet it too is subject to its own blockades : ( a ) will taxpayers always agree to the demands of medical invoicing ? ( 2 ) how can a single payer system prevent overuse of facilities by people taking advantage ? ( 3 ) how do we assure that hospitals and clinics do not go the route of the Veterans Administration, which in some cases offers substandard care ? If health care workers become, in effect, Federal employees, how do we motivate them to their best efforts rather than settling for job description minimums ?

As we seek to contain health care costs — as we must — all kinds of questions thus arise that few policy makers want to take on. This is why it takes a nurses’ strike to force legislators to answer for the almost un-answerable.

Mike Freedberg os a longtime political activist and operative in Massachusetts and the publisher of the Here and Sphere blog.

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