By Rhoda Baer via Wikimedia Commons

A state committee that most people have never heard of, the Health Care Cabinet, is planning to damage health care in Connecticut by disrupting the only thing that’s really working for us right now – our doctor-patient relationships.

I am a breast cancer survivor and caregiver to my severely injured husband. Our family has spent years struggling with Connecticut’s broken, insurance-driven health system. We know how badly the system needs reform, but the Cabinet, whose mandate is to find practical fixes, is making a big mistake by focusing on the wrong thing.

The Cabinet’s proposal is to scapegoat the responsibility for skyrocketing medical costs onto our doctors and health systems. The suggestion is for a “downside risk” payment scheme, that allows insurance companies and government agencies to set the costs of care, and to put a limit on how much health costs can grow per person in Connecticut. They want to create a new state agency that will oversee that process, which will have the authority to enforce that limit. Then if the cost of my care, my family’s care, your care, exceeds the set standard, our doctors and health systems will be required to pay any overage back to the insurers and the state, out of their own pockets!

The downside risk model is based on a new and as yet untested economic theory. In the few places it’s been tried, doctors and health systems are finding that they can’t meet the unreasonable cost limits, most of which they have no control over. This means that they are refusing sicker patients who require more and therefore costlier care. They are leaving this kind of model in droves.

We owe our lives to doctors, nurses, and all of the many others in the teams who care for us. They went to school to heal people. They are dedicated to relieving suffering and improving our lives. Downside risk places an enormous burden on them, ethically as well as financially. Connecticut providers who take their responsibilities seriously may be compelled to leave our system too, and we can’t afford to lose them.

The downside risk model will also encourage the creation of a parallel system of “concierge service” for those who can afford any extra expenses themselves, and a skeleton system for the rest of us. We will go backwards to the days when large numbers of us were forced into the ER to get care, costing huge amounts of tax money, and back to the bad old days when we couldn’t afford preventive or maintenance care.

As a cancer survivor, preserving my health requires vigilance. Access to the tests and treatments that keep me (and everyone else) well is the right thing to provide for the health of Connecticut, too. It saves money the right way, by preventing problems or finding them early when they are less expensive to treat. A regular mammogram is much cheaper than a mastectomy. But if doctors are driven out by downside risk, or are discouraged from recommending these critical diagnostic tests because they end up paying for them personally, who will prescribe these tests?

Connecticut is unique in many ways. As citizens and patients we are very fortunate to have incredible medical care available to us. There also are beacons of cost containment success in our state. Our state-run Medicaid program, which over the past few years has improved quality and increased access to more doctors, has dramatically cut frequent ER use, and actually lowered costs to the state, as consumers and politicians fret about rising health care costs elsewhere. That nationally-recognized success could easily be lost with the implementation of downside risk.

Of most immediate concern, the Cabinet wants to start imposing downside risk on our successful Medicaid program in two short years, and also to impose it on the state employees’ health insurance plan – not because it makes sense to start there, it doesn’t, but because they can use those state-run programs for a grand experiment.

I understand that we must work hard to control costs in Connecticut where we have failed to do so, that is, outside of the successful Medicaid program. But to put such crippling constraints on doctors and their patients is just plain wrong, and contrary to the best interests of Connecticut and its citizens.

Above all else, we must always remember that there is a person at the other end of a regulation. In the case of the downside risk model for medical care, it will probably be a suffering person. We as a society cannot afford that.

Gaye Hyre lives in West Haven.

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