Duke's Health Plan Contested

Gov. Michael S. Dukakis's proposed plan to guarantee affordable health care to every citizen in the commonwealth has met with strong opposition from hospital lobbies throughout the state who fear the plan's financial cap will devastate the quality of hospital care.

The governor's proposal, which is expected to cost close to $600 million a year, will almost completely restructure the financing and organization of Massachusetts health care to insure nearly 600,000 citizens who are currently uninsured.

The governor also aims to reduce the price of health care in Massachusetts, which is about 25 percent above the national average, with the use of a cost cap.

Currently, 10 percent of the state's workforce is not given insurance benefits by its employers. The remaining 90 percent of employers pay for their employees' health plans and subsidize the 10 percent who do not. The governor has said that his plan will shift the costs to the employers of the uninsured, while reducing the costs for the insured.

"We have a historic opportunity to provide health insurance for every single citizen [in the state]," said Andrew Dryfus, spokesman for the State Executive Office of Human Services. The governer, who is a candidate for the Democratic party's 1988 presidential nomination, has said that if the plan is successful in Massachusetts he will make it part of his national platform.

"There is strong consensus between legislators that Massachusetts can be the first state in the nation to have a universal health care policy," he said. The bill will be considered by the state legislature at the end of the month when the current health financing law expires.

But the Massachusetts Hospital Association (MHA), representing the administrators of all the hospitals in the state, opposes the bill because it contends a cost cap could severely threaten the quality of health care.

"We support access to health care for all, and a government program that can provide that access," President and CEO of Baystate Medical Center Michael Daly said. "However, that commitment carries with it a commitment to adequately fund the services that people need."

Daly said hospitals have been reducing expenses for five years, often through painful reductions in staff and services. He added that hospitals are now faced with a serious shortage of health professionals, a problem that will only intensify as budgets decrease.

"The cap will severely tighten our ability to provide patient care," said Janelle Heineke, director of Womens Health Service at Mt. Auburn Hospital. "This is a labor intensive concern, and a cap is not the way to resolve financial problems," she added.

The Harvard teaching hospitals are also united against the proposed cap, calling the measure "fiscally unrealistic."

Beth Israel, one of Harvard's affiliated hospitals, is expected to lose $10 million if the cap were implemented, according to the hospital's spokesman Marsha Zabarsky.

There is "a contradition which the governor hasn't really dealt with," Zabarsky said. "Health insurance is only as good as the health care you can buy."

The proposed cap will limit hospital costs to 2 percent higher than the rate of medical inflation. The plan's sponsors who have commissioned in depth studies on hospital budgets said hospitals can function efficiently under the cap.

"We believe the cap is very generous," said Dryfus. "State hospitals made a profit of $125 million last year, and the current bill will allow $256 million in funding, a net increase of 10 percent abouve last year," he added.

But Daly said the 2 percent cap will add only $180 million to the hospital system next year, while hospitals will require at least an additional $544 million to meet cost pressures.

"Our hospitals would face a $350 million shortfall under the governor's legislative proposal," he said.

The MHA staged a 5000-person rally in front of the Statehouse last week to protest the cap and give hospital employees an opportunity to meet with legislators.

The demonstrators, who included hospital trustees, doctors, nurses, administrators and volunteers carried signs which read, "CAPS= Catastrophe for underfinanced hospitals," "Duke Plan Hurts Quality Care at Hospitals," and "Governor's bill is bad medicine."

"Hospitals are at the brink of disaster," William Wane, president of Bon Secours Hospital, said at the rally. "Enough is enough, we're tired of being a whipping post for the financial ills of our society," he said.