UESTION 5 promises health care for everyone in Massachusetts and the freedom to go to any health care provider. It would instead deliver endless confusion to a health system already under stress, increase costs, and do nothing to extend coverage to the uninsured. It deserves a ''no'' vote on Nov. 7.
The authors of Question 5 give the Legislature a July 2001 deadline to have a universal coverage plan in place, but they leave it up to a special legislative committee to do the hard work - devising a way to pay for it. Yet Question 5 lacks the trigger mechanism to compel legislative action (for instance, a requirement that, absent universal coverage, all the uninsured would go on Medicaid). Without such a threat, the universal mandate is a mirage.
The greater impact of Question 5 would be on the managed care system, loathed by the most avid Question 5 supporters but essential to restraining costs. Question 5 would take a meat ax to the physician-network and utilization-review mechanisms that are the essence of managed care. Patients would be able to go to any health care provider they want, and the health plans would have to pick up the tab, except for a yet-to-be-determined surcharge on the patient. The ability of plans to deny unneeded treatments would be limited by the provision that providers could do whatever is ''medically necessary,'' an elastic term that would invite litigation.
Health plan premiums are already increasing in the 10 percent range, and it is unwise to impose rules promoting further escalation. Higher premiums will eventually result in fewer people being covered by health insurance, in contradiction to the goal of universal coverage proclaimed by Question 5 backers.
Fortunately, the state already has a law to protect the rights of patients without devastating the managed care system. The Legislature passed the patients' rights bill, Chapter 141, in July, thanks largely to the threat of Question 5. Many original supporters now oppose the question and want to give Chapter 141 a chance to work.
Some of those who still support Question 5 believe its passage will pressure the Legislature toward universal coverage. The Boston Globe strongly supports health coverage for everyone in the United States, but, by ducking the question of how to finance an exclusively Massachusetts system, Question 5 does nothing to advance the issue. Rather, it would make a mess of the managed care system as the Legislature and courts sort out the differences between it and Chapter 141. The health care system in Massachusetts is still among the finest in the world, and it would only suffer if exposed to the unnecessary pressures that would be applied by Question 5.
