David Brooks has cultivated an air of “moderation”, so yesterday's downright hysterical column comes as a surprise. Joel has commented on the substance, Dan Kennedy on its intemperate style. I'll just comment on Brooks' unsupported assertion that the Massachusetts plan is “coming apart at the seams.” Good faith criticisms of our new-fangled setup here are most welcome; hysteria, rush-to-judgement and off-with-their-heads condemnation are not. Brooks, unfortunately,indulged in the latter. That's a shame, because in spite of being wrong on facts and tone, he will likely take a few opinions with him.
So, at the risk of boring those of you who have heard this tune already, here goes …
The first thing to understand is that the 2006 law only dealt with access to insurance. It was a rearrangement of health care financing. It provided an insurance exchange, where you can compare plans. Importantly, the law built upon two principles that had been already established in Massachusetts law: Guaranteed issue and community rating. Guaranteed issue means that an insurer has to offer you coverage, regardless of pre-existing conditions. Community rating means that your risk is spread out over the population of folks roughly your age; so your pre-existing condition doesn't make your insurance unaffordable.
So, the results are this: 97% of Massachusetts residents have health insurance. Can any other state sniff that?
No, the 2006 law did not deal with cost control; that was considered too “heavy a lift”, in the parlance of the State House. It did, however, create an enormous incentive to deal with cost control, since it became very expensive for the state to provide subsidies for coverage. Insurers, businesses, and consumers have always been interested in cost control, for obvious reasons; now doctors and hospitals have started to feel pressure to deliver.
The state started the cost-control ball rolling in 2008. And perhaps most importantly, now the state is now re-inventing the whole game, setting up a system for paying for health, not volume of services (“global payment”). This is a big deal, with buy-in from payers and providers; it rolls out in the next five years.
Yes, the state has considered dropping legal immigrants from the subsidy rolls; but that's not a failure of the law, that's due to our enormous budget deficit. (You may have heard of that, Mr. Brooks — 48 other states have the same problem — or worse.)
But the takeaway is this: The Massachusetts health care law is indeed an enormous challenge for the state; but it is not “coming apart at the seams.” In fact, given current efforts, you might say that we're at work pulling the seams together.
Now, on the national level, Congress is considering cost controls:
- Expanding the role of MedPAC in Medicare payments — just added to the House bill due to some productive pressure from — dare I say it? — Blue Dogs! — and directly proving Brooks' thesis wrong.
- The Comparative Effectiveness Institute, which would at least make your health dollar more useful
- The influence of the public plan on the marketplace
- The health insurance exchange, which was a major reason why Ron Wyden's plan was (miraculously!) scored deficit-neutral by CBO.
So in many ways, the US Congress is more on top of cost control than we were here in 2006. Maybe it's not enough. Let's have that discussion, and make a better law. Brooks' hysteria will likely make it harder to get anything done, leaving us with the current system — which has truly been torn apart at the seams. Brooks seems to think that the Democrats should ignore the fact that they were elected for a couple of big reasons — and one of those explicit reasons was to pass universal health care. Get on it.
Update: Jay decides to poke us with a stick, so I will respond. Jay's effort at mind-reading as to the “real reasons” behind the push for universal health care is, well, a paranoid failure. There are indeed people who are wedded to single-payer universal health care, or bust; I'm not one of them, and I suspect most progressives aren't. I don't care whether big-government runs the system, or not, as long as it works. The current private system is a failure; so we pick up from there.
I make no apologies that I favor universal care for humane reasons, for reasons of human dignity. Everyone should be able to go to a doctor when sick. Gosh, is that the secret agenda? All things being equal, I would support it regardless of whether it cost more or not. But in light of the insane amount of waste in our system, and the effect on the economy, we can — must — do this while saving money.
Discuss
21 Comments . Leave a comment below.Obama simply cannot pass healthcare running even with Mr. Generic Republican.
The cost-cutting measures at the federal level are a smokescreen. They say they will cut Medicare/Medicaid reimbursements -- all that does historically is cause cost-shifting onto the private insurance plans. If Obama takes the private side public, there is nobody to cost shift onto.
Hey, what about that? Never thought of it, huh?
Are you proposing federally mandated wage reductions for doctors?
The current reimbursement structures that insurance companies (as well as government programs) provide, don't pay enough for basic care. As a result, doctors need to order expensive unnecessary tests in order to made a living. If you pay more for basic care and for consultations, and reduced the reimbursement for tests, you would see quality of care increase and costs decline.
Monitoring and correcting complex complicated legislation is a life sentence with no hope of parole. Thank the good Lord there are many smart and savvy folk inside and outside of state government that are working as a team to pull those seams together. We'll grow old together on that job.
I don't understand why people I respect have adopted Brooks the Conservative Pundit We Like. Yes, he occasionally says something insightful, but the core of his work is textbook conservatism. He's less mean than, say, Jonah Goldberg, but you know what, Craig Nettles was less mean than Thurman Munson.
I hate his appearances on NPR. Note how often he resorts to "Both sides do X" rhetoric to throw water on Republican scandals. That is what I would call a deceptive truth -- yes, Democrats have had fundraising scandals, but (to my knowledge) no figures to rival Jack Abramoff or Tom DeLay.
The Democratic Congress was thrown out in 94' for excesses far worse than Abramoff and Tom Delay. I think he was merely trying to say that the Dem sponsored anti-corruption line was a bit hypocritical in 06', especially when its architects oppose campaign finance reform, and especially when ABSCAM veterans like the unabashedly corrupt John Murtha were being elevated in party leadership. Frankly I think any politician running as someone who will clean up the system is akin to Claude Rains busting up Ricks while collecting his winnings. Blago was a reformer once too. So was Patrick for that matter.
But in any case I don't understand the Brooks hate, perhaps because I am a moderate. Sure he was a big Iraq hawk but so were Biden and Clinton and Kerry for that matter. Also again he endorses the Wyden plan which does provide for a public option, in fact a much more generous option than the House plan, its just that the Wyden plan is not shrouded in the budgetary gimmickry and actually bothers to specify how it will be paid for and attempts to be revenue neutral-you know things both liberals and conservatives can embrace-as opposed to the flawed House plan.
I just don't understand his lionization as a voice of reason. He is not.
"....excesses far worse than Abramoff and Tom Delay."
Care to quantify that? I sort of regard the creation of the largest pay for play organization in the history of the US as,... well,... the largest force for institutional corruption the country has ever seen.
I think five congressional indictments are worse than four and we had five that year the GOP had four in 06. Dan Rostenkowski literally stealing a few million to retire on in illegal campaign contributions, Speaker Jim Wright playing pay to play with his book deal, former Senator Bentsen charging lobbyists 30,000 a piece just for the priviledge of eating breakfast with him, etc.
I am simply saying Mr. Brooks was pointing out that both parties have their fair share of corruption, and nobodies hands are clean in that business.
... got there are examples of individual corruption, which is certainly bad. What you have with Delay is institutionalized corruption and extortion on a party-wide scale. Not that the business lobbyist community wasn't complicit, but that didn't make it any less corrupt. Quantity of individual cases, in this case, doesn't give an actual good measure of scale. The scale of what Delay was doing makes even Bentsen look like less than a lightweight.
He is usually pretty good about getting a clear message out. Hopefully he will provide some strong leadership on the health care issue.
in MA is a huge FAIL. First, they really were not clear with the voters that this wouldn't control costs, as you now seem to argue, "Oh, we all new this was just an accessibility plan". Second, our biggest safety net hospital is suing the state for diverting funds meant for free care to the poor to the states big private insurance scheme. Third, as reported in WSJ, lot's of people here are buying the private, for-profit insurance when they are really sick, and then dumping it when they are better because it is too cost prohibitive to carry, not exactly insuring they have good preventative care. Fourth, there is little evidence global payments will significantly reduce health care costs. Fifth, you only know what you measure. You pass a law that more people have to buy insurance, then yeah, more people are going to buy private insurance. That doesn't mean they are getting adequate care. Six, the social insurance is left vulnerable since not everyone enjoys it, as has happened with the 30k legal immigrants that the leg cut care to. Seven, premiums have risen here faster than they have nationally.
I do think we need social insurance, Medicare for All, and then I'm quite happy for people to buy supplementary private insurance on top of that, but the MA plan is no model for the country. Indeed, no OECD country pays for health care with employer mandated, private, for-profit insurance aside from us. We have worse health outcomes and pay nearly twice as much as France for our health care.
Private, for-profit health insurance is a market failure. One in eight health care dollars goes to profits. That's a market failure, and any plan that doesn't deal with that is going to fail to live up to it's goals.
Where do you think Medicare came from? Why did the gov develop it in the 60s and not in the 40s?
What about the Massachusetts private, for-profit, health insurance scheme is akin to Medicare? I really don't understand your question.
Actually a majority of the insurance companies in Massachusetts are non-profit insurers. Accuracy makes for a more credible argument.
Considering that, for instance, our three big non-profit HMO's pay huge sums of money for management to for-profit insurers.
In many respects, he's intelligent. Unlike most conservative pundits, he doesn't foam at the mouth; he doesn't spin to the point of lying. He's also one of a diminishing number who hasn't asked for Obama's birth certificate. Unlike the non-rabid, allegedly intelligent, George Will, he's rarely completely wrong when it comes to stating an issue.
He has one foot solidly planted in reality. He's an Eisenhower Republican, the kind that have been driven out of the national party and Congress.
Although his analysis is often good, he screws up when he starts to address a problem. He wants a smart answer, but then it comes out conservative.
My favorite comments of Brooks have dealt with Mitt Romney to whom he attributes a "clarity of mind" and for passing health care.
http://select.nytimes.com/2007...
I'm still waiting for confirmation that Romney was ever here.
There are plenty of very, very intelligent people whose opinions aren't worth squat. A lot lot lot of education and cleverness goes into rationalizing bad ideas and unexamined prejudices. I forget who said it and exactly how, but every great university cranks out its fair share of ignoramuses.
Im sure a few people here would argue me, some definitely say Mr. Brooks, and I can't disagree that Richard Pearle, Irving and William Kristol, Paul Wolfowitz, John Ashcroft, and Antonin Scalia are all ignoramuses.
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