New England Journal of Medicine Article Calls for Higher Taxes, Legislation to Expand Health Coverage

Two executives from Partners HealthCare System, Massachusetts' "largest and most influential hospital and physician network," on Thursday "issued a public appeal" for higher taxes and laws that would require all employers to provide health insurance to workers, the Boston Globe reports.

In an article in the New England Journal of Medicine, Partners CEO James Mongan and Thomas Lee, president of Partners' physician network, wrote that doctors should support mandatory employer-sponsored health coverage and higher taxes to fund expanded health care coverage. Although the article referred to possible reforms in Massachusetts, which is considering whether and how to expand health coverage to more than 460,000 uninsured state residents, the authors said the article was intended for a national audience.

The article did not address specific costs of expanding health coverage.

Mongan and Lee wrote, "How can a country as idealistic and generous as the United States fail repeatedly to accomplish in health care coverage what every other industrialized nation has achieved? One explanation may be that we are not so idealistic or generous as we would like to believe we are."

Lee said in an interview that doctors "can't just complain," adding, "You have to be willing to advocate for things not pleasant for people to hear."

The authors acknowledged in the article that new funding for health care would benefit hospitals and doctors. Mongan also noted that Partners' hospitals "in a way would be better off" if they did not treat large numbers of uninsured patients, adding, "But we do, and we should get credit for that."

NEJM Editor in Chief Jeffrey Drazen said Mongan and Lee "have an interesting perspective on the problem," adding, "We've heard a lot of people talking about how to save money on health care. They're saying maybe this is going to cost more money and we're going to have to face that. It's politically difficult, but these guys are not politicians."

Although Partners executives are "deeply involved behind the scenes" in the state's health care debate, Gov. Mitt Romney (R) and state Senate President Robert Travaglini (D) have "ruled out higher taxes and requiring employers to cover their workers," the Globe reports.

Eileen McAnneny, vice president for government affairs for the Associated Industries of Massachusetts, said employer mandates would not work because "most of the businesses that don't provide health insurance are small and they don't provide it because they can't afford to."

In an accompanying editorial, Richard Kronick of the University of California-San Diego wrote that any plan for universal coverage should include measures to reduce waste because "many resources are used in clinical and administrative activities that do little to improve health" (Kowalczyk, Boston Globe, 3/24).

The article by Mongan and Lee and the editorial are available online.