Tufts Health Plan CEO: Build On Employer-Based Healthcare Model

Les Masterson, for HealthLeaders Media , February 27, 2009

As the nation moves closer to major healthcare reform, who better to speak about universal coverage than Massachusetts healthcare leaders?

The Bay State is the closest to universal coverage with its system based on an individual mandate that requires everyone have health insurance. At the Transforming Healthcare forum in Boston Thursday, a group of Massachusetts healthcare leaders explored the issues of healthcare reform, the $150 billion healthcare portion of the stimulus package, and President Barack Obama's budget proposal.

James Roosevelt, Jr., president and CEO of Tufts Health Plan and member of the Obama Presidential Transition Team, said federal policymakers can learn from Massachusetts' reform. "The beauty of what we accomplished in Massachusetts, in addition to providing healthcare coverage in a cost-effective manner, is the legislation shined a light of day on healthcare costs. It was never framed as a true public policy before," said Roosevelt.

In his healthcare proposals, Obama has linked healthcare reform to stimulating the economy. Without major reforms at the federal level, the numbers of uninsured Americans will swell to 54 million within a decade. Losing coverage and facing rising healthcare costs will force many into bankruptcy. Echoing comments made by Obama on Tuesday, Roosevelt, the grandson of President Franklin Roosevelt, said healthcare costs force an American to declare bankruptcy every 30 seconds. "That is wrong and it must change," he said.

The health plan executive said the nation must build its reform program on top of the current employer-based system and not create a new system, such as single-payer, from scratch. "I don't think we can copy any system from another country that started with a different system," he said.

Roosevelt said major healthcare reforms should focus on four areas:

  • Ensuring quality and effectiveness
  • Improving the primary care system
  • Providing transparency for cost and quality
  • Addressing racial and income disparities

"This is a tall order and I don't have all the answers . . . I will tell you that the winds of change have come to Washington. We do have an unprecedented opportunity. We are on the verge of a national program that is as historic as any legislation in our time," said Roosevelt.

Roosevelt, who predicted senators Ted Kennedy and Max Baucus will present a healthcare reform package in the fall, said the road to reform will not be easy. He suggested healthcare leaders, policymakers, and stakeholders should discuss costs, but the debate should not devolve into fear mongering and inflammatory statements, which he charged is already happening on the topic of comparative effectiveness.

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