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July 31, 2009

Blue Cross Blue Shield of Massachusetts on Health Care Reform
At Blue Cross Blue Shield of Massachusetts, we are committed to working toward a health care system that offers high-quality, affordable care for all. As the largest health insurer in the state, we have been working with others to transform our health care system. And as the health care reform debate in Washington accelerates, Massachusetts' health reform efforts—which are now three years old—serve as an important model.

As a nation, we recognize that the rising cost of health care is unsustainable and that for the millions of people without health coverage, reform is sorely needed. The direction that national health care reform will take is still unclear, but it is critically important for the ultimate solution to address both access to health care and the quality and affordability of care for it to be truly effective.

Addressing Health Care Access Without a Government Plan
As a result of state health care reform, a record 97.5 percent of Massachusetts residents now have health coverage. This progress was achieved without the need for a government plan. And Massachusetts' historic health reform is proof that a government plan is not necessary.

Those in favor of a government plan believe it would be beneficial because it would bring more competition to the market; however, a government plan would have an unfair competitive advantage because it doesn't have to do all the things that private insurers have to do, such as:

• Complying with state mandates
• Making a margin
• Maintaining sufficient reserves

A government plan would also exacerbate the problem of cost shifting from public to private payers. Fortunately, the lesson of Massachusetts health care reform shows us that it is possible to provide near universal health coverage without jeopardizing people's access to care in the communities in which they live.

Moving Away From the Fee-for-Service System and Toward Quality
In 2008, Blue Cross Blue Shield of Massachusetts began changing the way that we pay for care to move away from the current fee-for-service model and toward a global payment system that rewards the quality of care. We believe that by working to reduce the misuse, overuse, and underuse of health care services, we will be able to lower the cost of health care while improving quality and access to care. Blue Cross Blue Shield of Massachusetts Chairman, President, and CEO Cleve Killingsworth explains that a "global payment system is the best way to improve health care quality while reducing costs because it encompasses every stage of care from prevention and treatment to recovery and end-of-life."

A special state commission recently voted unanimously to recommend that Massachusetts become the first state in the country to move away from the costly and wasteful fee-for-service system and toward a system of global payments with quality incentives. We feel that this step forward for Massachusetts health care reform is the right move for the state and represents an essential component of what is needed for national health care reform.

President Obama recently spoke about the need to change the way that we as a country pay for care—to pay for quality, not quantity. It is estimated that 30 cents of every health care dollar spent is wasted. If this waste could be eliminated, there is enough money in the system to cover the 46 million Americans who don't have coverage.

We believe that improving the health care delivery system by changing the way we pay for care must be a key component of any meaningful reform effort in Washington and are hopeful that this will be part of any national health care reform legislation. Our vision for the future of health care in America is a system that provides efficient, affordable, high-quality access to care for all. And we believe that by changing the way we pay for care, we will improve the care that we pay for.

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