Health Care Agenda for All

The national debate over health care reform is intensifying as President Obama presses ahead with an ambitious agenda for overhauling a system that has grown so enormous and so complicated that it is impossible to understand all the working parts.

And so it is with the health care reform legislation — people will take it one piece at a time, studying and informing themselves along the way. In a bill that runs for some sixteen hundred pages, there is sure to be something to offend everyone. Case in point: on the Commentary Page in today’s edition the chief executive officer of the Vineyard Nursing Association sounds a warning about possible negative impacts of the legislation on home care. Robert Tonti urges readers to contact their congressman and object to this aspect of the legislation.

But few can argue that reform is anything but the right track to be on, and of course the model for reform lies right here in Massachusetts where an experiment in mandatory health care coverage, while imperfect, is by most accounts working.

Cost containment is a central theme. The Gazette reported recently on the fee structure for outpatient procedures at the Martha’s Vineyard Hospital, which is extraordinarily high for many routine procedures. For example, a first trimester ultrasound for a pregnant woman is more than eight times higher than the same procedure done at a comparable hospital on Cape Cod or the south shore. And why is that?

Hospital chief executive officer Timothy Walsh could offer only a bland explanation of the sky-high Island hospital fees. Costs are simply higher on the Vineyard, he said. A wholly unsatisfactory answer to a substantial question. But it leads quickly to the matter of insurance. Because insurance pays for the bulk of most hospital procedures, these high hospital fees hit people in their pocketbooks somewhat gently, through copayments. But when the bill comes and shows that the hospital charged thousands of dollars for a procedure that costs hundreds in other places, it certainly is cause for concern.

And for thinking, this is a system that has somehow gone very badly wrong.