So, with health care reform (or "reform") apparently barrelling down the pike, we always knew the devil was going to be in the details. And now, all stakeholders will find themselves challenged — ethically, economically, strategically — as to what they’ll accept in the final bill. For some, a personal mandate is an absolute non-starter; for others (our Gov), no tax increase whatsoever; for some, slot machines as a revenue stream are out (I’m certainly not crazy about them); for some, an employer assessment is straight out, while some won’t sign on to a bill without one.
Yup, it’s a mess — and it always is with health care policy. Just like health plans and the government playing hot potato with expensive cases (people), we’re all now playing hot potato with who gets the mandate to cover: Is it government (ie. single payer, funded who knows how), is it the individual (Mitt’s plan), or is it employers ("pay or play")?
I’d like to suggest that if our various leaders and stakeholders pick one of these three bases to cling to tenaciously at all costs, we will go nowhere, or to a place that no one is happy to be.
In his must-read article about the various paradigms of health care, Malcolm Gladwell makes a distinction between "actuarial" insurance — by which individuals pay more or less depending on their risk level, or else they skip out entirely — and "social" insurance, in which the protection provided by the insurance is considered a social good, a necessity extended to all members of society as a matter of civic morality.
The three-part hot-potato discussion that’s happening in the State House right now is limiting because we have not come to the necessary moral conclusion: Making sure that folks can see a doctor if they have to is a social good, something a civilized culture does for its members.
Yes, that’s regardless of socio-economic status, race, class or gender; regardless of good luck or bad; good genes or bad; regardless of smarts or lack of smarts; morality or immorality (and who among us is capable to sit in judgement of our neighbors?). There are all kinds of things in life that depend on moral virtue; access to health care simply should not be one of them.
I support the Health Access and Affordability Act and the MassACT ballot initiative, not because they’re perfect, but because it seems to me that those bills have some sense of the shared sacrifice — yes, sacrifice — that will be necessary to do the right thing. But let’s be clear: this is a three-legged table, and without each of the legs no reform will stand. Individuals, either as taxpayers or as insurance-consumers, will have to stand up. Employers, either as taxpayers or as providers of insurance, will have to stand up. And government will have to stand up and facilitate logistically and financially.*
Really, my bottom line is to protect the bodies of Massachusetts citizens, for moral and economic reasons. There are better and worse ways to do that, but let’s keep our eyes on the prize, be ready to sacrifice in good faith, and demand that others be willing to do the same.
*Yes, you can say that taxpayers and government are the same, but government also receives revenue from non-tax sources like the lottery and tolls, and from taxes on things not used by everyone, like cigarettes. Think of smoke taxes as "usage fees".
Charley,I’m glad you cited the M. Gladwell article – I think its an important perspective to reflect on as policy makers jump headlong into the strategic negotiations. My concern all along has been that the discussion and clear articulation that health care is a social good has not happened. Given this, at this time, there is no moral compass to getting to a good result; rather its likely to be political expediency. Since opportunities to make substantial policy changes come cyclically, it would be a shame to cobble something together that works for politics but not for people in the long run. Had DiMasi spent the past year thinking about this, like Romney and Travaglini, we wouldn’t be in this rush at the last minute. Solutions to health care are complex and involve many stakeholders- the only way to rise above it is with strong leadership and a reminder of the social good. Alas, I’m feeling dubious
Toll money is legally restricted to use on the Mass. Turnpike. Lottery and cigarettes are hugely regressive.You just don’t know about poor people’s lives up there in Cambridge, do you!
naysayer,Higher cigarette taxes are generally regressive, but they tend to get cigarette consumption down too which would cut down on health care costs. The MassACT proposal would provide funding for smoking cessation products. So, it’s not like we’d be asking everyone to quit cold turkey.
naysayer: I live in Medford now. I take the 96, 94, 101, 95, and 134 buses.Stereotype much?