Today’s Boston Globe has a lead article about the higher than expected costs for Massachusetts’ healthcare program implemented to create near universal insurance coverage. The costs of this program have been greater than expected due primarily to more people joining the subsidized health insurance program. (This greater than expected number has been attributed to underestimates of the actual number of uninsured in Massachusetts prior to the start of the Commonwealth Care program.)

The higher costs are certainly a problem for the state’s budget – although almost 50% of these costs may be paid for by the Federal government under the state’s Medicaid waiver. However, concerns about these cost overruns are in contrast to the Medicare Part D prescription drug benefit, which has been costing less than originally expected…… In part because fewer than the expected number of people have enrolled in Part D plans. Despite this, Medicare Part D has come under attack for it’s high costs – among other reasons.

The compare & contrast lesson here is that costs and access are like twin suns circling each other. One or the other can be dominant, but the two effect each other. Policy makers and pundits can praise or pummel each of these plans for their high costs or failure to cover more people, but the reality is more access will – at least initially – require additional spending. While cost containment can certainly be part of any acess expansion plan, it often requires reduced benefits or cutting reimbursements (or their growth rate) for specific clinicians, services or products, but these actions often have negative consequences down the road. Paraphrasing what the head of a national healthcare foundation stated a few months ago: “Lousy insurance can be provided inexpensively.” (And the inverse is true too – Inexpensive insurance can be lousy.)

What do you think?