Mar. 16, 2010: Martha Coakley on health care costs

>> Rooney: TONIGHT ON
"GREATER BOSTON," THE COST
OF HEALTH CARE IN
MASSACHUSETTS.
ATTORNEY GENERAL MARTHA
COAKLEY AND WHAT IS
DRIVING YOUR COSTS UP.
PLUS THE ANNUAL SPECTACLE
OF MARCH MADNESS IS HERE.
WHY ONE FORMER COLLEGE
STAR IS SUING TO GET PAID.
>> Rooney: GOOD EVENING.
AS CONGRESS PREPARES TO
VOTE ON HEALTH CARE REFORM
AS EARLY AS THIS WEEK,
ATTORNEY-GENERAL MARTHA
COAKLEY RELEASED A REVIEW
OF WHAT IS DRIVING THE
COST OF HEALTH CARE IN
MASSACHUSETTS.
THE YEAR-LONG STUDY FOUND
THAT SIMPLE PRICE
INCREASES FOR SERVICES
ACCOUNTED FOR MUCH OF THE
SPIKE.
SURPRISINGLY, IT IS NOT
DUE TO MORE OR UNNECESSARY
TESTS BEING PERFORMED.
THERE WAS ALSO A
SIGNIFICANT DIFFERENCE IN
PAYMENT RATES FOR DOCTORS
AND HOSPITALS, AS MUCH AS
200%.
THE STUDY FOUND THAT
BASICALLY THE FREE MARKET
DRIVES THE HIGHER RATES.
AND JOINING ME NOW IS
MASSACHUSETTS
ATTORNEY-GENERAL MARTHA
COAKLEY.
WELCOME.
>> THANK YOU.
>> Rooney: I ASK THIS
QUESTION OVER AND OVER AND
OVER AGAIN.
I GOT A LETTER FROM A GUY
LAST WEEK, HE SHOWED ME
HIS HEALTH CARE PLAN.
TUSTS.
HE HAD BEEN TRACKING FOR
12 YEARS.
IT WENT UP 43% THIS YOR
FOR HIS WIFE, HIS
16-YEAR-OLD DAUGHTER AND
HIMSELF.
HOW CAN THAT BE?
>> IT IS, AND THAT'S PART
OF WHAT IS DRIVING THE
HEARINGS THAT WE'RE
INVOLVED IN RIGHT NOW.
IT IS BEHIND THE
LEGISLATION TO TAKE A LOOK
AT IT BECAUSE IT IS A
PROBLEM FOR THAT FAMILY.
IT IS A PROBLEM FOR
EMPLOYERS WHO ARE BUYING
INSURANCE.
AND IT IS A PROBLEM FOR
THE STATE, OBVIOUSLY.
KEEP IN MIND, WE'RE AHEAD
OF EVERYBODY ELSE IN TERMS
OF HEALTH CARE REFORM
BECAUSE WE HAVE EVERYBODY
ENSURED, BUT NOW WE'RE
EMBARKING ON HOW DO WE PAY
FOR THIS.
WE'RE IN THE MIDDLE OF
THREE DAYS OF HEARINGS
AROUND WHAT DRIVES THOSE
COSTS, AND COMING FROM
THAT, HOPEFULLY WHAT CAN
WE DO TO KEEP THEM DOWN.
>> Rooney: A GUY LIKE
THIS IS SAYING IF I CAN'T
AFFORD TO PAY MY TUFT'S
PLAN, I'M GOING TO HAVE TO
GO TO THE STATE PLAN.
HOW DOES THAT HELP ANY OF
US?
>> WELL, AND THIS IS WHY
IT IS SO COMPLICATED.
BECAUSE WE HAVE A SYSTEM
THAT WE EXPECT TO BE GOOD,
AND WE HAVE VERY GOOD
HEALTH CARE IN
MASSACHUSETTS.
THERE IS NO QUESTION ABOUT
IT.
WE HAVE INSTITUTIONS THAT
PROVIDE FIRST RATE QUALITY
HEALTH CARE AND WE HAVE A
GOOD HEALTH CARE SYSTEM.
THEY'RE ALL ORGANIZED AS
NOT FOR PROFITS,.
>> Rooney: WHICH IS
RIDICULOUS.
>> IT CAME OUT OF A
SYSTEM, AND IT JUST GREW,
AND THIS IS ONE OF THE
THINGS EVERYBODY IS
LOOKING AT.
BUT IT ALSO ISN'T SUBJECT
TO THE KINDS OF
COMPETITION AND TRARNS
TRANSPARENCY THAT YOU
EXPECT IN OTHER MARKETS,
LIKE GETTING INSURANCE FOR
YOUR HOME OR YOUR CAR.
>> Rooney: YOU LOOK AT
BLUE CROSS, BLUE SHIELD,
WHICH LOST $149 BILLION,
AND FORCED THE C.E.O. OUT.
IF THIS WERE A PUBLIC
INSTITUTION, THEY ALL
WOULD HAVE BEEN
ACCOUNTABLE IN A DIFFERENT
WAY.
BUT THE FACT THAT IT IS
NOT, THAT IT'S A
NOT-FOR-PROFIT -- AND, BY
THE WAY, THEY HAVE TO MAKE
MONEY IN ORDER TO SURVIVE.
CAN'T THIS STEM -- NOT
THAT WE WANT THE STATE
REGULATING EVERYTHING
UNDER THE SUN, BUT IT
SEEMS TO ME -- I KNOW THE
GOVERNOR HAS LOOKED INTO
THIS IN TERMS OF
DOUBLE-DIGIT INFLATION ON
HEALTH CARE INSURANCE
POLICIES, BUT CAN YOU
REGULATE THIS TO SOME
EXTENT?
>> WELL, ONE OF THE
QUESTIONS ON THE TABLE IS
WHAT CAN WE DO ABOUT IT.
WE HAD A COUPLE OF
SPEAKERS TALKING ABOUT THE
ABILITY TO REGULATE, BUT
NOT OVERREGULATE.
IF THIS WERE A GOVERNMENT
AGENCY, IT COULD BE
REGULATED.
IF IT WERE A FOR PROFIT --
>> Rooney:
ACCOUNTABILITY.
>> IT IS KIND OF IN THE
MIDDLE.
IT IS NOT REALLY THEIR
FAULT.
THEY HAVE GROWN UP AND
OPERATING IN A SYSTEM
SEEKING FOR EXCELLENCE.
THEY PICK UP COSTS THAT
AREN'T REIMBURSED
PROPERTYLY -- PROPERLY BY
THE FEDERAL GOVERNMENT.
HAVING SAID THAT, WE ALL
RECOGNIZE THAT THE FINAL
CONSUMER WHO KNOWS HIS
PREMIUMS ARE GOING UP, HAS
NO IDEA WHAT THE HEALTH
CARE COSTS ARE.
AND THEY DON'T NO WHAT
THINGS COST.
SO WE HAVE A SYSTEM WHERE
IT IS NOT CLEAR THAT OTHER
THAN THE MARKET
LEVERAGE --
>> Rooney: EXPLAIN WHAT
THAT IS, THE MARKET
LEVERAGE.
THAT IS SOMETHING THAT YOU
CAME UP WITH TODAY.
DOESN'T THAT BASICALLY
MEAN THEY HAVE LEVERAGE IN
THE MARKET TO SET THE
PRICE AT ANYTHING THEY
WANT BECAUSE IT IS A FREE
MARKET, AND AS YOU'VE
STATED EARLIER, THIS IS A
PLACE WHERE PEOPLE COME TO
GET REALLY GOOD QUALITY
HEALTH CARE.
PEOPLE WILL PAY FOR IT, SO
THEY LEVERAGE THE MARKET
TO WHAT THE MARKET WILL
BEAR?
>> IN SOME RESPECTS, THAT
IS RIGHT.
AND PARTLY BECAUSE YOU
WOULD EXPECT PRICES TO
COORDINATE WITH MAYBE THE
QUALITY OR THE COMPLEXITY
OF THE SERVICE, OR MAYBE
AN ACADEMIC COST OR WHAT
HAVE YOU.
HIGHER PRICES BECAUSE THEY
DO OTHER THINGS.
OUR STUDY SHOWS THAT THAT
IS NOT THE CORRELATION
HERE.
SO IT REALLY, ALTHOUGH
PEOPLE MAY HAVE THOUGHT
THAT, OR SUSPECTED IT OR
SCENE IT ANECDOTELY, OUR
INSPECTION SORT OF LAYS
THAT OUT.
NOW WE HAVE BECAUSE
SOMEONE IS ABLE TO, AND
THEY ARE CONTRACTING FOR
PRICES, THEY'RE NOT
RELATED TO WHAT THE
CONSUMER -- THE ULTIMATE
CONSUMER -- MIGHT THINK.
BUT THIS IS A HUGE FIRST
STEP TO BE ABLE TO SHOW
THIS INFORMATION, AND IT
HAS ALREADY HAD AN IMPACT
IN THE MARKET.
IN TERMS I'VE GOTTEN
LETTERS FROM CITIES AND
TOWNS AND OTHERS THAT ARE
RENEGOTIATING RATES.
PART OF WHAT WE WANT
PEOPLE TO DO IS SAY, YOU
NEED TO LOOK AT WHAT
YOU'RE PAYING FOR AND WHAT
YOU'RE GETTING IN RETURN.
AND THE FACT THAT A
PARTICULAR BRAND OR NAME
SEEMS TO BE MORE VALUABLE
MAY NOT BE TRUE.
>> Rooney: THIS IS SUCH
AN IMPORTANT THING BECAUSE
I NEVER REALLY THOUGHT
ABOUT THIS BEFORE.
BUT I HAD SOMEBODY ON FROM
ATHENA HEALTH WHO SAID
PEOPLE DON'T ACTUALLY KNOW
WHAT IN THEIR POLICY.
FOR INSTANCE, I HAVE NO
IDEA WHAT IS IN MY POLICY.
THEY TAKE IT OUT OF MY
PAYCHECK EVERY WEEK FOR
W.G.B.H., AND I HAVE NO
IDEA.
CAR INSURANCE, YOU KNOW A
LITTLE BECAUSE YOU HAVE TO
LOOK AT IT.
AND THEY FORCE YOU TO HAVE
THINGS --
>> AND IF YOU HAVE AN
ACCIDENT, YOU HAVE TO PAY
FOR, INSURANCE PAYS FOR
IT, BUT YOU KNOW WHAT IT
COSTS.
YOU MAY GO IN FOR AN AP AP
APPENDEC TOMY, AND YOU
DON'T CARE.
IT DEPENDS -- AND IT
DEPENDS ON THE GROUP
YOU'RE IN.
IT MAY NOT FILTER DOWN TO
AN INDIVIDUAL THE WAY IT
WOULD IN A CAR.
IT IS A COMPLICATED
SITUATION.
WE'RE TALKING ABOUT HEALTH
CARE.
WE'RE TALKING ABOUT
ORGANIZATIONS, AND IT'S
NOT AN EXACT SCIENCE.
YOU KNOW, WE PAY FOR THE
EXPERTISE AND THE
EXPERIENCE OF A DOCTOR
THAT'S DIFFERENT FROM
GETTING INTO A CAR
ACCIDENT.
HAVING SAID THAT, I THINK
PART OF WHAT OUR REPORT
DOES, AND WHAT SOME OF THE
TESTIMONY TODAY BEFORE
THIS NEW DIVISION THAT IS
SUPPOSED TO LOOK AT COST
CONTAINMENT, SAYS WE NEED
TRANSPARENCY, AND WE NEED
TO HAVE BETTER INFORMATION
FOR COSTUMERS SO THEY CAN
START TO BARGAIN LIKE IN A
FREE MARKET.
WHAT'S THE COSTS, AND
WHAT'S THE VALUE OF WHAT
YOU'RE PAYING FOR.
>> Rooney: AND MAYBE
BLUE CROSS BECAUSE I WAS
FOCUSING ON THAT, BUT IT
SEEMS TO ME THERE HAS TO
BE MORE CREATIVE WAYS TO
DO THIS.
BLUE CROSS HAS A SECTION
OF ITS POLICY OFFERING
COVERAGE BASED ON A FLAT
RATE.
YOU PAY, WHATEVER IT IS,
$1500 A YEAR, AND YOU GET
EVERYTHING COVERED FOR
THAT.
SO THEN YOU DON'T --
EVERYTHING DOESN'T -- THE
HOSPITAL DOESN'T GET
REIMBURSED FOR EVERY
SINGLE THING IT DOES.
>> WE MOVE TO PAYING FOR A
FEE FOR SERVICE, FOR AN
M.R.I., OR GOING TO A
SPECIALIST.
WE USED TO DO THIS.
IT WAS CALLED CAPITATION,
AND YOU HAVE INSURANCE FOR
PEOPLE WITH MORE DIFFICULT
HEALTH CARE PROBLEMS.
BUT YOU TAKE AWAY THE
INCENTIVE.
I DON'T MEAN THIS IN A BAD
WAY TO SEGMENT THAT YOU
GET PAID EVERY TIME YOU
SEE SOMEONE.
FOR A PRIMARY CARE
PHYSICIAN, YOU WOULD LIKE
HIM TO SPEND MORE TIME
WITH 20 PATIENTS AND DO
MORE PREVENTION.
INSTEAD OF GETTING
REIMBURSED FOR SEEING 35
PATIENTS.
DOCTORS DON'T LIKE IT, AND
WE'VE GOTTEN INTO A SYSTEM
THAT WORKS THAT WAY.
THERE IS A HUGE MOVE TO
MOVE AWAY FROM THAT FEE
FOR SERVICE AND LOOK AT
MORE PREVENTION, AND
PROVIDE AN INCENTIVE FOR
PROVIDERS AND FOR
INSURANCE COMPANIES TO
LOOK AT WELLNESS.
NOT THAT PEOPLE SHOULDN'T
GET THE HEALTH CARE THEY
DESERVE.
BUT THEY SHOULDN'T GET
SEGMENTED HEALTH CARE AND
IT SHOULD BE FOCUSED ON
WHAT THAT PERSON NEEDS AT
A PARTICULAR TIME.
>> Rooney: HERE IS A
SERIOUS QUESTION: WHO IS
GETTING RICH OFF OF THIS?
THE DOCTORS CLAIM THEY ARE
NO LONGER.
AND THE INSURANCE
COMPANIES CLAIM TO BE
LOSING HUNDREDS OF
MILLIONS OF DOLLARS, WHICH
SEEMS IMPOSSIBLE TO ME --
LOVE TO GET A LOOK AT
THOSE BOOKS -- AND THE
CONSUMER CERTAINLY ISN'T.
WHO IS MAKING THE MONEY?
THE PHARMACEUTICAL
COMPANIES?
>> THE PHARMACEUTICAL
COMPANIES MAKE MONEY, BUT
THEY HAVE HUGE INVESTMENTS
IN SOME DRUGS.
ADMINISTRATION HAS BECOME
COMPLICATED.
WE HAVE A LOT OF
ADMINISTRATIVE COSTS BUILT
IN.
IN HEALTH CARE, MONEY HAS
SHIFTED TOWARDS
SPECIALTIES.
IN THAT RESPECT, OVER ALL
THE POPULATION SUFFERS
BECAUSE THERE IS NOT A LOT
OF MONEY IN THE PRIMARY
CARE.
>> Rooney: PEOPLE LIKE
DERMATOLOGISTS?
>> SOMEONE WHO BECOMES AN
EXPERT IN A NICHE CAN, IN
THEIR MARKET, COMMAND
THOSE KINDS OF PRICES.
PART OF WHAT WE'VE SEEN IF
WE WANT TO KEEP COSTS DOWN
AND WE WANT TO GET DOWN TO
A PRIMARY CARE, AND PEOPLE
CAN COME IN AND SEE A
FAMILY PRACTITIONER, AND
NOT SEE A SERIES OF
SPECIALISTS WHERE NOBODY
OWNS THE PROBLEM, WE NEED
TO HAVE INCENTIVES FOR
PEOPLE WHO WANT TO
PRACTICE MEDICINE, WANT TO
BE FAMILY SPECIALISTS, AND
FAMILY CARE PHYSICIANS.
AND PART OF WHAT WE'RE
DOING IN THESE HEARINGS IS
TAKING A LOOK AT EXACTLY
THAT.
WHERE IS THE MONEY GOING?
WHAT IS RELATED TO WHAT WE
EXPECT TO GET IN TERMS OF
A VALUE BASIS.
>> Rooney: WHAT DO YOU
WANT TO COME OUT OF THAT?
WHAT ARE THE INSURANCE
COMPANIES GOING TO DO WITH
THAT INFORMATION?
THEY GO, THAT'S
INTERESTING.
>> NOT REALLY.
THEY CAN'T DO THAT
ANYMORE.
BECAUSE AS WE'VE HAD THESE
DISCUSSIONS IN THE PAST
AND THROUGH THESE
HEARINGS, EVERYBODY IN
MASSACHUSETTS, ON THE
NOT-FOR-PROFIT SIDE, ON
THE GOVERNMENT SIDE AND
THE EMPLOYERS' SAID WE
WANT TO FIRST GET
EVERYBODY INSURED, WHICH
WE'VE DONE, AND WE'RE
GOING TO TRY TO CONTAIN
COSTS.
THEY ARE PART OF THIS.
THEY UNDERSTAND THE NAME
OF THE GAME HAS CHANGED.
THE SYSTEM CAN'T SUSTAIN
ITSELF.
WE EXPECT AND HOPE THAT
THE VERY PEOPLE IN THE
INDUSTRY PROVIDING MEDICAL
CARE KNOW THAT FOR THEM TO
CONTINUE TO KEEP
MASSACHUSETTS ON THE FRONT
OF THE LINE ON THIS HAVE
TO BE INVOLVED IN THIS
DISCUSSION.
THEY'VE BEEN COOPERATIVE
IN THIS INVESTIGATION.
THEY'RE AT THESE HEARINGS.
AND I HOPE THEY WILL BE
INVOLVED IN THE SOLUTION
GOING FORWARD.
>> Rooney: DO YOU
SUPPORT THIS INTERSTATE
SITUATION WHERE OTHER
COMPANIES CAN COME IN HERE
AND COMPETE AND BREAK DOWN
ALL OF THE BARRIERS WITH
HEALTH INSURANCE?
>> IT IS ONE POSSIBILITY
TO PROVIDE FOR
COMPETITION.
WHAT IS SO COMPLICATED
ABOUT THIS IS THAT YOU
CAN'T JUST DO THAT.
YOU CAN'T, FOR INSTANCE,
HAVE GLOBAL PAYMENTS.
FRANKLY, THAT'S WHY IT HAS
TAKEN 25 YEARS TO DO
HEALTH CARE REFORM.
>> Rooney: I DON'T
UNDERSTAND WHY YOU CAN'T
TAKE YOUR INSURANCE AND GO
SEE A DOCTOR IN NEW YORK.
>> IT DOESN'T WORK THE WAY
CAR INSURANCE MIGHT WORK
BECAUSE IF YOU WANT TO
HAVE THE KINDS OF CARE AND
PAYMENT MADE, YOU CAN'T
REALLY OUTSOURCE THAT FOR
PEOPLE WHO ARE LOCATED
HERE.
IF YOU BUY INSURANCE IN
NEW YORK, HOW DO THEY
REIMBURSE THE HOSPITAL
HERE.
A LITTLE TOUGHER THAN CAR
INSURANCE.
BUT WE'RE WORKING ON IT.
>> Rooney: I SAW YOUR
APPEARANCE ON THE
BREAKFAST -- I SAT THROUGH
THAT ENTIRE THREE HOURS,
WHICH WAS PAINFUL.
IT PROBABLY WAS MORE
PAINFUL BEING THERE.
THE QUESTION EVERYBODY
WANTS TO KNOW, MARTHA IS:
WHERE DID YOU BUY THE BARN
JACKET BECAUSE EVERYBODY
WANTS TO BUY ONE.
>> I STILL HAVE THE TAGS
ON IT.
>> Rooney: ARE YOU GOING
TO BRING IT BACK?
>> NO, NO, NO.
I'M GOING TO KEEP IT
BECAUSE IT FITS REALLY
WELL.
SOMEBODY GOT IT FOR ME, IT
WAS A PRESENT.
NOT FROM SCOTT BROWN.
>> Rooney: IT WAS VERY
SIMILAR TO THE ONE HE
ACTUALLY HAD?
>> ABSOLUTELY.
I'M GOING TO WEAR IT ALL
THE TIME (LAUGHING).
>> Rooney: AND THE OTHER
GAG WAS CURT SCHILLING.
WHEN YOU SAID YOU WERE A
YANKEES FAN, DID YOU MEAN
IT TONGUE IN CHEEK?
>> IT WAS A BAD JOKE.
I WAS ON A RADIO SHOW, AND
WE WERE TALKING ABOUT RUDY
GIULANI, AND I SAID HE IS
A YANKEES' FAN.
AND THE QUESTION CAME
ABOUT CURT SCHILLING, AND
I MADE THE JOKE HE WAS A
YANKEES' FAN --
>> Rooney: THAT WAS A
GOOD JOKE.
>> NO, IT WASN'T A GOOD
JOKE, BUT I DID KNOW WHO
CURT SCHILLING WAS.
>> Rooney: WE TALKED
AFTER YOUR LOSS FOR THE
SENATE SEAT, AND HOW HAS
IT BEEN?
>> I'M BACK AT WORK.
WE HAVE GREAT STUFF WE'RE
DOING AROUND CYBERCRIME
AND THE HEALTH CARE
HEARINGS.
AND THERE IS A LOT OF WORK
TO DO.
AND A LOT OF THE WORK I
GET TO STILL DO AS
ATTORNEY-GENERAL.
>> Rooney: AND -- AND
THE DENTIST IMPLANTING
PAPERCLIPS, CAN YOU SAY
THE NAME OF THE DENTIST?
>> HIS NAME IS MICHAEL
CLAIR.
>> Rooney: OH, MY GOSH,
THAT'S MY DENTIST -- NO.
>> AND ANYBODY WHO DID GET
A ROOT CANAL FROM HIM, IS
FREE TO CHECK WITH OUR
OFFICE.
HE WAS USING PAPERCLIPS,
BUT HE WAS CHARGING
MEDICARE FOR THE REAL
THING.
AND WE NEED TO SAVE MONEY.
AND WE DO THAT, TOO, WE DO
MEDICAID FRAUD.
>> Rooney:
ATTORNEY-GENERAL MARTHA
COAKLEY, ALWAYS A PLEASURE
TO HAVE YOU HERE.
>> THANKS.