{"id":306532,"date":"2025-11-22T05:34:22","date_gmt":"2025-11-22T05:34:22","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/306532\/"},"modified":"2025-11-22T05:34:22","modified_gmt":"2025-11-22T05:34:22","slug":"finding-a-doctor-and-paying-for-care-shouldnt-be-so-hard","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/306532\/","title":{"rendered":"Finding a doctor and paying for care shouldn\u2019t be so hard"},"content":{"rendered":"

One study<\/a> by a physician recruiting agency found the average wait time in Boston for an appointment with a family physician is 63 days. The Massachusetts Health Policy Commission has found<\/a> that residents are having an increasingly hard time accessing primary care, and roughly 40 percent of 2023 emergency department visits were for conditions that could have been prevented or treated with timely access to primary care.<\/p>\n

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A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr.<\/p>\n

Health care is expensive, with high premiums, deductibles, and copays. In 2024, Massachusetts\u2019 health insurance premiums for employer-based coverage were the highest nationwide<\/a>, with the average annual cost of health care for a family exceeding $32,000, according to the Health Policy Commission. In 2023, 29 percent of Massachusetts residents didn\u2019t get needed health care because of cost, according to the Center for Health Information and Analysis<\/a>. <\/p>\n

Neil Abramson of Leominster, who owns ECi consignment stores, testified at the state\u2019s annual Health Care Cost Trends hearing on Nov. 12 that he had surgery this year to remove a cancerous tumor. With insurance, the surgery still cost him $4,000, not including follow-ups. \u201cThe barriers to health care are huge,\u201d Abramson said.<\/p>\n

Federal policy changes will make the situation worse. The state estimates around 300,000 people will lose publicly subsidized insurance over the next decade because of the One Big Beautiful Bill Act\u2019s work requirements, more frequent eligibility determinations, and immigration-related eligibility changes, according to the Blue Cross Blue Shield of Massachusetts Foundation<\/a>. If Congress declines to extend the Enhanced Premium Tax Credits<\/a>, which expire next month, an estimated 337,000 residents who buy insurance through the Health Connector will see premiums rise this January by an average of $1,364 per person per year, according to the Health Connector<\/a>.<\/p>\n

Massachusetts has long had one of the nation\u2019s highest rates of people with insurance due to a mandate imposed in 2006 requiring anyone who can afford it to buy health insurance or pay a fine. But as health care takes a bigger chunk out of family budgets, families are faced with difficult decisions about what care \u2014 if any \u2014 to get, and what insurance \u2014 if any \u2014 to buy. <\/p>\n

As Attorney General Andrea Campbell said at the Health Care Cost Trends hearing, \u201cBusiness as usual isn\u2019t working to curb the growth of health care costs, and patients as a result are suffering.\u201d<\/p>\n

However, finding ways to lower costs often feels like the childhood game where everyone puts their finger to their nose and says, \u201cnot me.\u201d Lower drug prices? The problem isn\u2019t us, drugmakers say, pointing at pharmacy benefit managers, the middlemen between drugmakers, insurers, and pharmacies who negotiate drug prices and formularies. Limit insurance rate increases? Insurers point at physician prices. Lower hospital prices? Hospitals point to government\u2019s low Medicaid reimbursement rates.<\/p>\n

The best news to emerge from the Health Care Cost Trends hearing is there seems to be willingness in the industry to tackle access and affordability. But there is no silver bullet.<\/p>\n

Improving primary care access means changing the economic reality that primary care doctors are paid far less than specialists for a job that\u2019s increasingly difficult. Politicians including former Governor Charlie Baker<\/a>, a Republican, and state Senator Cindy Friedman<\/a>, a Democrat who cochairs the Committee on Health Care Financing, have proposed bills to require health care providers and insurers to spend more money on primary care and less on specialists. Putting a larger share of money into primary care could help retain doctors and hire support professionals like medical scribes and physician assistants.<\/p>\n

Other proposals could tinker around the edges: establishing more primary care residencies<\/a> at community health centers or creating medical school student loan repayment or tuition assistance programs conditioned on graduates working in primary care. <\/p>\n

On affordability, there may be ways to use technology to lower costs through replacing some office visits with telehealth visits, using remote monitoring<\/a> to reduce pregnancy complications, or replacing ambulances with cheaper vehicles<\/a> for routine transport. <\/p>\n

But lowering costs substantially will require systemic change to address factors like administrative burdens<\/a>, unwarranted provider price variations<\/a>, and payment systems that incentivize more care, not better care.<\/p>\n

Providers also complain that requesting prior authorization from insurers is burdensome. There may be ways to limit the therapies that require prior authorization while using improved technology \u2014 or something as simple as standardized forms \u2014 to make obtaining approval easier. At the hearing, Fallon Health president and CEO Manny Lopes said there may be ways for medical records systems to communicate better, so providers don\u2019t duplicate tests. Regulators can also reduce burdens: Michael Lauf, president and CEO of Cape Cod Healthcare, said his organization filled out 51 different surveys this year, with various regulations imposing annual, biannual, monthly, biweekly, weekly, and daily reporting requirements.<\/p>\n

The popularity of expensive GLP-1 drugs points to another challenge of affordability and access. Many insurers stopped covering the drugs for weight loss, not because they don\u2019t work but because they\u2019re too expensive<\/a> in the United States. (In other developed countries, these drugs are sold more cheaply<\/a>.) President Trump\u2019s work negotiating lower prices for direct-to-consumer sales<\/a> will help, but also creates a system where mainly the wealthy can afford them.<\/p>\n

Drug pricing is complex, with pharmacy benefit managers negotiating prices and formularies in ways that can result in anti-competitive practices and higher prices<\/a>. At the hearing, Sarah Emond, president and CEO of the Institute for Clinical and Economic Review, suggested there may be ways to completely rethink the system<\/a>, potentially eliminating the complicated rebate system in favor of having a reasonable list price available with little red tape. <\/p>\n

Other forward-thinking ideas that will become vital when gene and cell therapies come on the market (which can cost millions of dollars for one treatment) include value-based models<\/a> in which insurers pay for a therapy over time in installments, as long as the treatment remains effective.<\/p>\n

Kevin Tabb, president and CEO of Beth Israel Lahey Health, said ultimately, cutting costs out of the system means doing less. The state is conducting a planning process to determine how each region\u2019s health care needs compare to the supply. That will be vital for figuring out what services to provide, and where. <\/p>\n

As policy makers consider complex systems, the bottom line must be finding ways to help people like Svedlow\u2019s wife and Abramson find doctors and afford care. <\/p>\n

Shira Schoenberg can be reached at shira.schoenberg@globe.com<\/a>. Follow her @shiraschoenberg<\/a>.<\/p>\n