Choose: Choice is good or bad

Boston Globe columnist Steven Syre offers a thoughtful political view of health care issues in Massachusetts today. An excerpt:

The latest edition of an annual health care poll conducted by Mass Insight suggests most people don’t find the price they pay for health coverage to be a serious problem. The poll, which will be officially released next week, also shows a large majority of people don’t want to give up anything when it comes to health coverage or the freedom to choose whom they see for medical help.

... A majority of people polled said they disapproved of limiting coverage for high-cost and experimental treatments as well as policies that limit coverage for prescription drugs. A whopping 80 percent were against limiting consumer choice of doctors and hospitals.

I found this to be interesting because it is consistent with polls I have seen over the years. It suggests a disconnect between the policymakers and the general public, particularly on the issue of choice. But, perhaps there is an understandable reason for this disconnect: People have no sense of what it costs to get medical services at different hospitals; and they have no sense of the relative efficacy and safety of treatment in those hospitals. Maybe if they knew, they would be more amenable to paying less and getting equal or better care.

Last year, when the MA Payment Reform Commission issued its report promoting a move to global payments, many people who were enthusiastic about the report skimmed over the issue of patient choice. Limiting patient choice is a sine qua non if the state is serious about changing the mode of payment to a capitated system. But we do not have to have a repeat performance of the disaster of managed care from the past. Transparency of payment rates and clinical results is a necessary condition for success.