Our guest blogger is Emily Oshima, a Research Associate/Policy Analyst with the Health Policy team at American Progress.

On Monday, Gov. Deval Patrick of Massachusetts again urged state lawmakers to address rising health care costs in his annual state of the state address. Patrick first introduced a bill, “An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments,” in February 2011 in an effort to achieve comprehensive delivery system and payment reform.

Patrick’s proposal calls for replacing the current fee-for-service payment system, which creates incentives for providers to deliver more services – even unnecessary care, with a global payment system, which encourages more coordinated patient care and rewards providers for better patient health. It aims to “significantly reduce” fee-for-service payments by the end of 2015 and, as Patrick explained, “stop paying for the amount of care, and start paying for the quality of care.”

The Massachusetts bill encourages greater price transparency, consumer protections against rate increases, and medical malpractice reform to reduce the costs of defensive medicine. The legislation creates incentives for providers to better coordinate patient care and lower costs through Accountable Care Organizations (ACO). Such arrangements have already improved care for more than 100,000 Blue Shield of California patients in California and San Francisco, where better coordination among health care providers has flattened premium increases, lowered hospital readmissions by more than 20 percent, and saved $20 million in 2011.

Numerous hospitals, physician groups and insurers across the nation are adopting the ACO model in hopes of duplicating this success. For instance, Massachusetts is already home to nine ACO entities and 32 health care organizations are participating in HHS’ Pioneer ACO initiative to improve care and lower costs for Medicare patients.

Health reform in Massachusetts was wildly successful in expanding coverage to more than 98 percent of the population and now lawmakers must tackle their next big challenge: cost control.

Frank Donatelli

Start with Medicare. The trustees who run the program have been telling us for some time that the current benefit and financing system is unsustainable. Indeed, its 2010 report notes that the Medicare “trust fund” will be exhausted five years sooner than previous estimates.

The passage of “Obamacare” has made this deplorable situation worse. This law does increase various Medicare taxes and includes some cost-containment features. However, as Medicare’s own actuary has pointed out, “Obamacare” uses the savings not to strengthen Medicare but to start another unfunded entitlement. The changes — a $500 billion cut in the program — do nothing to shore up the existing Medicare trust fund.

The $500 billion in cuts Donatelli is touting is not coming out of the current Medicare budget. Rather, the law slows the program’s growth by reducing spending over the next 10 years,” phasing out overpayments to private insurers in Medicare Advantage, eliminating waste, and lowering annual payment updates to encourage more efficient care.

As a result of these savings, reform improves the sustainability of Medicare — precisely what Donatelli is so concerned about! The latest Medicare trustees report concludes that if Congress had failed to pass the ACA, the Health Insurance Fund would have started to run out out of money in 2016. But because of the law, the trust fund won’t face a shortfall until 2024.

– Zachary Bernstein

The last legal public hanging in America took place in 1936 in Owensboro, Kentucky. The “event” attracted 20,000 people and turned into such a sickening spectacle that many credit it with ending the practice in the U.S.

But one North Carolina Republican believes that as a country we’ve grown soft since banning public hangings and is calling for them to reinstated as a deterrent to crime. If Rep. Larry Pittman had his way, “abortionists, rapists, and kidnappers” would be first in line for the gallows:

Republican Rep. Larry Pittman, who was appointed to the District 82 House seat in October, expressed his views in an email sent Wednesday to every member of the General Assembly. [...]

“We need to make the death penalty a real deterrent again by actually carrying it out. Every appeal that can be made should have to be made at one time, not in a serial manner,” Pittman wrote in the email. “If murderers (and I would include abortionists, rapists, and kidnappers, as well) are actually executed, it will at least have the deterrent effect upon them. For my money, we should go back to public hangings, which would be more of a deterrent to others, as well.”

As ThinkProgress reported, last year Republicans in South Carolina, Nebraska, and Iowa pushed legislation that would essentially legalize the murder of abortion providers. Such radical sentiments have been echoed by prominent conservatives like Sen. Tom Coburn (R-OK), who said during his 2004 campaign, “I favor the death penalty for abortionists.”

At last night’s GOP presidential debate, Rick Santorum challenged Mitt Romney on the similarities between the health care reform he signed into law as governor of Massachusetts and President Obama’s Affordable Care Act. “Your mandate is no different than Barack Obama’s mandate. It is the same mandate,” Santorum charged. “You take over 100 percent, just like he takes over 100 percent, requires the mandate. The same fines that you put in place in Massachusetts are fines that he puts in place in the federal level. Same programs.”

The comparison immediately put Romney on the defense, who claimed, “I didn’t say I’m in favor of top- down government-run health care,” and explained that he expanded access to “private insurance” and allowed people to “choose any plan” within a state-run exchange. “There’s no government plan,” he added. “And if you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn’t have insurance, then we have to care for them in the hospitals, give them free care. So we said, no more, no more free riders.”

Romney’s description of his plan sounded so much like Obama’s rational for the federal health care law that ThinkProgress has compiled a video comparing how both politicians describe their reforms. Watch it:

Indeed, Romneycare and Obamacare share more than a dozen common provisions, for a full comparison, click here.

Politico’s Jonathan Allen and Manu Raju have an interesting report detailing Democrats’ frustrations over Sen. Ron Wyden’s (D-OR) decision to join hands with Rep. Paul Ryan (R-WI) and offer a bipartisan Medicare premium support plan that, while certainly not as radical as the original GOP blueprint, would likely increase costs for seniors and put the program on the road towards greater privatization.

You can read the full policy analysis of Wyden’s proposal here and here, but Democrats are worried that Wyden is also undermining the politics of Medicare reform by providing Republicans with “bipartisan” cover for their ultimate goal — complete privatization of the Medicare program:

“It neutralizes the weapon,” Sen. John Cornyn, chairman of the National Republican Senatorial Committee, said in an interview. [...]

Asked if there was frustration among Senate Democrats with Wyden over Medicare, Senate Majority Whip Dick Durbin (D-Ill.) told POLITICO: “I’ve heard that sentiment expressed.” But he quickly added that he’s also heard “some say that initiating a bipartisan conversation that will preserve Medicare is worthwhile. So let’s see if the Ryan-Wyden approach meets that test.”

Privately, the criticism is more biting. “Democrats believe in Medicare and, rather than bolster it, Wyden undermined a great issue for us all so he could grab a couple of headlines,” one furious Democratic source said. “Just embarrassing.”

Wyden stresses that his plan preserves traditional fee-for-service Medicare as an option for seniors — and it does, while also shrinking its impact and market power and undermining its effectiveness. What’s even more troubling, however, is that Wyden is cashing in one of the Democrats’ most important chips in this debate: Medicare’s large market power and success in containing health care costs. He is accepting the GOP’s alarmism about Medicare’s future — which isn’t nearly as dire as they suggest — and laying Medicare on the table as a legitimate target for further cuts. That kind of approach not only muddles the Democrats’ political message (we will strengthen this efficient government-sponsored program, while Republicans aim farm it out to private insurers), but also greatly increases the likelihood of greater privatization and coverage erosion in the future.

At last night’s CNN presidential debate in Jacksonville, Florida, the GOP candidates told an unemployed woman in need of health insurance that they would repeal the health reform law that could help her find coverage and giver her a tax deduction to go out and find her own insurance.

The woman — Lynn Frazier — said she found herself “unemployed for the first time in 10 years and unable to afford health benefits.” Under the Affordable Care Act, Frazier may qualify for temporary insurance in the state’s high-risk pool, which already provides coverage for 3,285 Floridians who can’t find affordable coverage elsewhere. In two years, she’ll be able to pick out a health policy through the state’s Exchange. All private insurers will offer a comprehensive basic set of benefits and allow consumers like Frazier to compare and contrast different plans to find the coverage that works best for them and their family. Insurers won’t be able to deny insurance based on past illness or rescind coverage unexpectedly, as they often do in today’s health market, and Frazier will pay a “community” rate and may even qualify for tax credits to help her afford her premiums and out of pocket cost-sharing expenses.

The Republican candidates pledged to undo these benefits and instead encouraged her to find coverage “as an individual” — on her own — with the help of a government tax deduction:

– RON PAUL: And you should have an opportunity — medical care insurance should be given to you as an individual, so if you’re employed or not employed, you have — you just take care of that and you keep it up.

– NEWT GINGRICH: She ought to get the same tax break whether she buys personally or whether she buys through a economy. She should also be able to buy into an association so that she’s buying with lots of other people so it’s not single insurance, which is the most expensive kind.

– MITT ROMNEY: What we should do is allow individuals to own their own insurance and have the same tax treatment as companies get. You do that and people like this young woman would be able to own her insurance. The rates would be substantial lower for her buying it individually than if she had to buy it individually today.

– RICK SANTORUM: All three of these folks sound great and I agree with them. I would just add that health savings account, which I introduced 20 years ago with John Kasich, is really the fundamental reform of getting consumers back involved in the health care system.

Watch the exchange:

In reality, sending off Americans to face health care insurers on their own without first reforming the individual health care market — so that companies can no longer deny coverage due to pre-existing conditions, rescind insurance, or charge sicker and older people substantially more — is an inadequate solution that will do little to lower the number of uninsured or reduce health care costs.

Since insurers are hoping to attract the most profitable beneficiaries, individual plans offer “coverage so riddled with loopholes, limits, exclusions, and gotchas that it won’t come close to covering their expenses if they fall seriously ill.” As a Consumer Reports investigation concluded, individual insurance policies are “more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst.” The lack of effective consumer protections in most states also allows insurers to trick consumers by selling plans with “affordable” premiums “whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.”

Thus, if an individual falls ill under the GOP’s proposal, the cost of the medical episode and the inadequate insurance will outweigh any beneficial tax treatment and deplete any health savings account they may have.