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发帖数: 61690 | 1 【 以下文字转载自 USANews 讨论区 】
发信人: lczlcz (lcz), 信区: USANews
标 题: 支持巴马care的哈佛教授们现在傻比了
发信站: BBS 未名空间站 (Mon Jan 5 15:25:35 2015, 美东)
Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty
By ROBERT PEAR
January 5, 2015
WASHINGTON — For years, Harvard’s experts on health economics and policy
have advised presidents and Congress on how to provide health benefits to
the nation at a reasonable cost. But those remedies will now be applied to
the Harvard faculty, and the professors are in an uproar.
Members of the Faculty of Arts and Sciences, the heart of the 378-year-old
university, voted overwhelmingly in November to oppose changes that would
require them and thousands of other Harvard employees to pay more for health
care. The university says the increases are in part a result of the Obama
administration’s Affordable Care Act, which many Harvard professors
championed.
The faculty vote came too late to stop the cost increases from taking effect
this month, and the anger on campus remains focused on questions that are
agitating many workplaces: How should the burden of health costs be shared
by employers and employees? If employees have to bear more of the cost, will
they skimp on medically necessary care, curtail the use of less valuable
services, or both?
“Harvard is a microcosm of what’s happening in health care in the country,
” said David M. Cutler, a health economist at the university who was an
adviser to President Obama’s 2008 campaign. But only up to a point:
Professors at Harvard have until now generally avoided the higher expenses
that other employers have been passing on to employees. That makes the
outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was
and remains a very generous employer.”
In Harvard’s health care enrollment guide for 2015, the university said it
“must respond to the national trend of rising health care costs, including
some driven by health care reform,” otherwise known as the Affordable Care
Act. The guide said that Harvard faced “added costs” because of provisions
in the health care law that extend coverage for children up to age 26,
offer free preventive services like mammograms and colonoscopies and,
starting in 2018, add a tax on high-cost insurance, known as the Cadillac
tax.
Richard F. Thomas, a Harvard professor of classics and one of the world’s
leading authorities on Virgil, called the changes “deplorable, deeply
regressive, a sign of the corporatization of the university.”
Mary D. Lewis, a professor who specializes in the history of modern France
and has led opposition to the benefit changes, said they were tantamount to
a pay cut. “Moreover,” she said, “this pay cut will be timed to come at
precisely the moment when you are sick, stressed or facing the challenges of
being a new parent.”
The university is adopting standard features of most employer-sponsored
health plans: Employees will now pay deductibles and a share of the costs,
known as coinsurance, for hospitalization, surgery and certain advanced
diagnostic tests. The plan has an annual deductible of $250 per individual
and $750 for a family. For a doctor’s office visit, the charge is $20. For
most other services, patients will pay 10 percent of the cost until they
reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a
family.
Previously, Harvard employees paid a portion of insurance premiums and had
low out-of-pocket costs when they received care.
Michael E. Chernew, a health economist and the chairman of the university
benefits committee, which recommended the new approach, acknowledged that “
with these changes, employees will often pay more for care at the point of
service.” In part, he said, “that is intended because patient cost-sharing
is proven to reduce overall spending.”
The president of Harvard, Drew Gilpin Faust, acknowledged in a letter to the
faculty that the changes in health benefits — though based on
recommendations from some of the university’s own health policy experts —
were “causing distress” and had “generated anxiety” on campus. But she
said the changes were necessary because Harvard’s health benefit costs were
growing faster than operating revenues or staff salaries and were
threatening the budget for other priorities like teaching, research and
student aid.
In response, Harvard professors, including mathematicians and
microeconomists, have dissected the university’s data and question whether
its health costs have been growing as fast as the university says. Some
created spreadsheets and contended that the university’s arguments about
the growth of employee health costs were misleading. In recent years,
national health spending has been growing at an exceptionally slow rate.
In addition, some ideas that looked good to academia in theory are now
causing consternation. In 2009, while Congress was considering the health
care legislation, Dr. Alan M. Garber — then a Stanford professor and now
the provost of Harvard — led a group of economists who sent an open letter
to Mr. Obama endorsing cost-control features of the bill. They praised the
Cadillac tax as a way to rein in health costs and premiums.
Dr. Garber, a physician and health economist, has been at the center of the
current Harvard debate. He approved the changes in benefits, which were
recommended by a committee that included university administrators and
experts on health policy.
In an interview, Dr. Garber acknowledged that Harvard employees would face
greater cost-sharing, but he defended the changes. “Cost-sharing, if done
appropriately, can slow the growth of health spending,” he said. “We need
to be prepared for the very real possibility that health expenditure growth
will take off again.”
But Jerry R. Green, a professor of economics and a former provost who has
been on the Harvard faculty for more than four decades, said the new out-of-
pocket costs could lead people to defer medical care or diagnostic tests,
causing more serious illnesses and costly complications in the future.
“It’s equivalent to taxing the sick,” Professor Green said. “I don’t
think there’s any government in the world that would tax the sick.”
Meredith B. Rosenthal, a professor of health economics and policy at the
Harvard School of Public Health, said she was puzzled by the outcry. “The
changes in Harvard faculty benefits are parallel to changes that all
Americans are seeing,” she said. “Indeed, they have come to our front door
much later than to others.”
But in her view, there are drawbacks to the Harvard plan and others like it
that require consumers to pay a share of health care costs at the time of
service. “Consumer cost-sharing is a blunt instrument,” Professor
Rosenthal said. “It will save money, but we have strong evidence that when
faced with high out-of-pocket costs, consumers make choices that do not
appear to be in their best interests in terms of health.”
Harvard’s new plan is far more generous than plans sold on public insurance
exchanges under the Affordable Care Act. Harvard says its plan pays 91
percent of the cost of care for a typical consumer, while the most popular
plans on the exchanges, known as silver plans, pay 70 percent, on average.
In many states, consumers have complained about health plans that limit
their choice of doctors and hospitals. Some Harvard employees have said they
will gladly accept a narrower network of health care providers if it lowers
their costs. But Harvard’s ability to create such networks is complicated
by the fact that some of Boston’s best-known, most expensive hospitals are
affiliated with Harvard Medical School. To create a network of high-value
providers, Harvard would probably need to exclude some of its own teaching
hospitals, or discourage their use.
“Harvard employees want access to everything,” said Dr. Barbara J. McNeil,
the head of the health care policy department at Harvard Medical School and
a member of the benefits committee. “They don’t want to be restricted in
what institutions they can get care from.”
Although out-of-pocket costs over all for a typical Harvard employee are to
increase in 2015, administrators said premiums would decline slightly. They
noted that the university, which has an endowment valued at more than $36
billion, had an unusual program to provide protection against high out-of-
pocket costs for employees earning $95,000 a year or less. Still, professors
said the protections did not offset the new financial burdens that would
fall on junior faculty and lower-paid staff members.
“It seems that Harvard is trying to save money by shifting costs to sick
people,” said Mary C. Waters, a professor of sociology. “I don’t
understand why a university with Harvard’s incredible resources would do
this. What is the crisis?” |
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