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Will He Make History?

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Tom Menino already has by ensuring that he will be mayor of Boston for 20 years. 20 years. Boston has been an American city for only two and a quarter centuries. 20 years is a long time. Things have gotten better over those two decades, and there is a promise that the Mayor has made to use his “political capital”, as he put it, to make major changes. To make history. We are rooting for the mayor, and we hope that he can use the 15-part series that we did together with the Boston Municipal Research Bureau on the major issues facing our fair city as buoys as, in his final four years, he takes the ship of city government […]

Federal health care mandate and the Commerce Clause

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Robert Levy, chairman of the CATO Institute, is a brilliant guy. He was talking today in Asheville about the fact that conservatives and liberals both abuse the interstate commerce clause in the US Constitution, for their own purposes. Liberals have used it to clamp down on everything from growing your own produce (in FDR’s time) to promoting any number of regulations on businesses, even those that only operate within a single state’s boundaries. Conservatives have been pushing, and continue to push, tort reform through federal action. Levy’s argument is that both abuse the commerce clause. But then he noted something I hadn’t thought of: What allows the federal government to establish a mandate to purchase health care insurance? Even though […]

Rethinking EMTALA

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On the drive in this morning I heard an interesting idea being tested in Fort Worth Texas (isn’t that one of the highest health cost cities in the country?).  See the link here http://www.nbcdfw.com/news/local-beat/Call-An-Ambulance-Get-a-Taxi-66723887.html.     They are using EMTs as triage agents for patients who call 911 for an ambulance.  In many cases, the EMTs are telling patients, “you don’t need to go to the hospital.” If the patient insists on visiting the ER, and it is not an emergency, the EMT calls a cab.     Policymakers should re-think how EMTALA  (the Emergency Medical Treatment and Active Labor Act) gets operationalized and whether it needs some updating to encourage appropriate use of our scarce resources.   With the flu season upon […]

Just. Not. Smart.

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The Governor is now talking about layoffs. I suppose Pioneer is responsible for starting the discussion about headcount growth a year ago, when we suggested that the data is telling us that state government grew from 2004 to then by about 7500 positions. We said it in October 2008, January 2009 and then again in June 2009. Our view is that the addition of 1,100 safety net program positions during that period should be maintained but that an equivalent of the 6,400 new hires are not sustainable in the face of thousands of local layoffs and over a billion-dollar-plus structural deficit. That’s been the mantra over and over. Over the past five months or so we’ve been asking the state’s […]

Let the Patients Choose

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(Editor’s Note: Pioneer welcomes our Senior Fellow on Healthcare, Amy Lischko, to the blog. Amy will be writing on healthcare here from time to time, as well as working on research for Pioneer. Welcome.) It’s worrisome when the state tells us what kind of provider network we need.  Today’s Globe article “Insurer told to hold off in Mass.” highlights one of the reasons behind our increasing health care costs.  Carriers have often remarked that they have difficulty creating both tiered provider networks and narrow provider networks that offer lower costs.  Why can’t the state (via the Connector or DOI) allow Centene to offer these plans to consumers and let the consumers vote with their feet?  If no one signs up, […]