IN THE STATES: Massachusetts Doctors Strongly Support State Reforms

Massachusetts doctors strongly support their state's three year old health reform initiative, according to a study appearing in the New England Journal of Medicine.

Seventy percent of practicing physicians in Massachusetts -- specialists and primary care doctors -- support health reform, and 75 percent want to continue the policies (although nearly half want some changes), according to the Harvard School of Public Health study funded the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation.  

Only 13 percent of physicians in the state oppose the health reforms created through the legislation, and just seven percent believe the policies should be repealed.

The findings suggest that it is possible to provide near-universal coverage of the population and have a resulting system that most physicians believe improves care for the uninsured without undermining their ability to provide care to their patients," said Harvard professor Robert Blendon, one of the study's authors, (and as our regular readers know, a favorite go-to guy for insights into to the politics of health reform.)

IN THE STATES: Massachusetts Health Reforms Are Bold, But Will They Succeed?

With Congress on its summer break, it seems like a good time to take a look at what's going on in Massachusetts. The state is covering 97 percent of its people. Costs remain a challenge -- but Massachusetts is moving diligently and creatively toward solutions.

The New York Times noted in an editorial this Sunday:

Massachusetts' experiment in universal health coverage has become a favorite whipping boy for opponents of health care reform. They claim the program is a fiscal disaster and that the whole country will be plunged into similar disaster if President Obama and Congress' s Democratic leaders have their way.

That is an egregious misreading of what is happening in Massachusetts. The state's experience so far suggests that it is more than possible to insure almost all citizens, and stay within planned budgets -- although it will take great creativity and political will to hold down risings costs so that the program is sustainable.

IN THE STATES: The Massachusetts Good, Bad, and Ugly

We all know that Massachusetts has come further than any other state in covering everyone. We also know that it's cost more than expected, and the state is now exploring some significant payment changes to make sure that it spends smarter on health care that actually improves health. It's also worth paying attention to an innovative program called Senior Care Options that deals with both the medical and long-term care needs of the elderly -- in a way that saves money, which Massachusetts needs to keep its health care coverage commitments.

The California Supreme Court Offers A Suggestion for Constitutional Convention

The California Supreme Court's decision today to uphold Prop 8 is more about the California constitution and the initiative process (the true winner in the case) than it is about same-sex marriage. In effect, by a 6-1 vote, the court makes plain that it would have loved to overturn Prop 8--but couldn't because of the constitution.

And in the following passage from today's decision, the court seems to offer a suggestion to advocates of a constitutional convention: that the state needs provisions limiting the ability of the people to change certain parts of the constitution by initiative. The political problem with this is, of course, that advocates of such a convention desperately want to avoid having issues like same-sex marriage brought into the debate over a convention.

Anyway, here's the relevant passage:

Here's An Economic Stimulus Idea: Overturning Prop 8

Two new studies from the Williams Institute at the UCLA School of Law look at the economic impacts on Massachusetts five years after that state legalized same-sex marriage.

One study, which looked at data from the American Community Survey, found that same-sex marriages had a small but positive impact on the caliber of the workforce. "This study shows that in Massachusetts marriage equality resulted in an increase of younger, female, and more highly educated and skilled individuals in same-sex couples moving to the state."

The other study, based on a survey and the crunch of state-collected tax revenue data, estimates that same-sex marriages produced a net economic benefit to the state of $100 million. 

Unintended Marijuana Consequences

Last year, Massachusetts voters decriminalized the possession of small amounts of marijuana. But several cities and towns have responded by adding or increasing penalties for marijuana use in public, the Boston Globe reports.

IN THE STATES: Economic Crisis, Fire, Can't Prevent Health Reform From Moving Forward

Even in this economic downturn, Massachusetts continues to move forward in its efforts to provide affordable health coverage to all its citizens.

The 10-member board which runs the state's subsidized health insurance program, Commonwealth Care, unanimously approved an update to the program's affordability schedule. That means that people in the lowest-cost plans will not have to pay higher monthly premiums. Individuals that choose a higher cost plan may actually find themselves paying less, Secretary of Administration and Finance Leslie Kirwan told the Boston Globe.

Commonwealth Care provides low-cost or no-cost coverage to roughly 164,000 of the Massachusetts who make too much to qualify for Medicaid, but would be unable to acquire health insurance on their own. Currently, residents making less than 150 percent of the federal poverty level (about $15,606 for an individual living in the Bay State), pay no monthly premium. Those with higher incomes pay on a sliding scale.

COVERAGE: Jobless Scramble to Find Massachusetts Insurance Niche

Our readers know that we give Massachusetts a lot of credit for forging ahead with its program to cover everyone, although we recognize the economic and logistical challenges. The Boston Globe takes a closer look at how families are cobbling together coverage, even in Massachusetts, where unemployment has reached a 15 year high. Here are three stories that the Globe's Kay Lazar found when she looked "at the people behind the statistics."

Vivian Izuchi, 53, a married mother of three, lost her job as director of a church after-school program. She got another similar job fairly quickly, a blessing in this economy. But the last one had health coverage. This one doesn't. "I am investigating everything and anything I can," she told the newspaper, as she sorts through a "maze of state-subsidized programs" to see if her family qualifies. Her husband is now unemployed, so no on-the-job insurance option there.

HEALTH REFORM: The Way We Are is the Way to Where We Could Be

We are a bit late getting to Atul Gawande's New Yorker article on health reform, and we wondered whether to post, or whether many of you had read it. But then we remembered a lesson from a complicated pregnancy: even during three months of strict bedrest, it's impossible to keep up with the New Yorker. So for those of you who still have the magazine with this excellent piece on your bedside table, here goes:

The essay, "Getting There From Here," starts with the obvious: people who don't have health insurance have sad stories to tell, and sad stories can compel a society to change. At least it compelled every other major industrialized democracy (and some non-industrialized, non-democracies, but Gawande doesn't dwell on those) to make sure people get health care. But maybe we are at the point finally when we, as a society, with a new leader, will find those stories not just sad but unconscionable.

COST: We're Hooked!

Maybe we need to stop thinking of health spending as a policy problem and start thinking of it as an addiction. Maybe we need a 12-step program. No, we're in a nasty recession, better make it a 6-step program.

That's how Nancy Turnbull of Harvard's School of Public Health has begun to think about health spending. She posted her "Six Step Program for Controlling Health Care Costs in Massachusetts" on the Commonhealth blog of WBUR public television. (Hat tip to Elizabeth Cooney of the Boston Globe's health blog for spotting this) Massachusetts is facing some unique cost problems as it pushes ahead with its full coverage program, but a lot of what Turnbull writes is widely applicable. It's also a fun read.

Here's the gist: