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A shrinking dependency ratio

But fewer younger, healthier people are joining the state’s workforce to defray the costs incurred by the older, sicker population. Thus spake the Boston Globe this morning and their assessment is correct. The Commonwealth’s population is stagnant. We are losing young workers even as we gain dependents. Their focus, however, is another matter. We must begin with the fundamental question, which in this case is: Why are so many young workers leaving the state? The easiest answer to that question is the high cost of living. And, yes, double digit increases in health insurance premiums are part of the problem. Its crux, however, is not health insurance; it’s housing. We should be focused on ways to reduce the cost of […]

Goodbye, Camelot

Mr. Robert Goulet, the pride of Lawrence, died yesterday. You may be more familiar with his work in Camelot and Man of La Mancha, but for those of us weaned on ESPN, he will always be remembered for the series of faux-lounge college basketball commercials he made during the 90s. Pure genius.

Drip, drip, drip

Ever heard of the “Heart Law“? It says that certain public safety officers who develop hypertension or heart disease shall be assumed to have developed said condition in the line of duty and puts the burden of proof on the employer to demonstrate otherwise. There is currently legislation wending its way through the Legislature, in informal session, with no debate or roll call votes, that will extend this law to county corrections officers. I don’t know if its a good law or a bad law. But our 2006 report on pension costs prompts me to ask the following questions: 1) How much will this bill add to the pension liability? and 2) Who will pay for it? Wait, I think […]

An Interesting Idea — Behind the Counter Medications

A recent op-ed in the LA Times calls for certain medications to be prescribed by pharmacists. This suggestion is on a continuum with a few other ideas that move select portions of medical practice from its traditional delivery mode to more convenient and cost-effective (but still clinically rigorous) modes. Increasing the practice rights of nurse practitioners and allowing Minute Clinics are ideas along these lines. The gist of the idea is that for certain medications, it is a appropriate for a pharmacist to prescribe directly to customers who come in and complain of specific symptoms. This should be familiar to anyone whose ever gotten mildly ill in Europe — where the practice is widespread. Although this seems like common sense, […]

Murray’s Healthcare Moment

The prospect for dynamic reform on Beacon Hill seemed slight a week ago. New initiatives seemed to be breaking down in a familiar pattern — Governor proposes ‘bold, new’ (expensive) initiative, Legislature promises ‘careful, in-depth’ review (and plenty of revisions. Then, Senate President Murray gave her speech at Wednesday’s Greater Boston Chamber of Commerce meeting. She proposed the following: 1) Public hearings to document the causes of premium increases above 7 percent 2) Realigning of payment methodologies to encourage quality and efficiency, not just the volume of services provided. 3) Increased recruitment of primary care providers 4) Allowing nurse practitioners to serve as PCPs for some patients 5) Permit “limited service clinics” proposed by the Department of Public Health. 6) […]