That’s how I feel about the health care bill. I’m happy that more
people will be covered under MassHealth (est. 92,500 by FY2009) or the
new Commonwealth Care program (est. 207,500 by FY09); ambivalent,
because the personal mandate will
doubtless hit some people — like the self-employed — pretty hard,
especially those somewhat (but not glamorously) above the subsidized
level (about $30k per year).
As many have pointed out, the bill punts on any number of really
- What is an “affordable” premium for an uninsured person above the
subsidized income level? Right now the word is that a bare-bones plan
might cost $325 a month for an
individual; and let’s not kid ourselves, that is a lot of money for
someone below median income.
“It is all a question of what it is going to cost people,” notes
Dukakis. ”If a guy making $30,000 is going to have to come up with
$3,600 or so, you are hitting people of very moderate incomes pretty
- What are you paying
for? If it’s a high-deductible plan, you’re basically paying for the
right not to go into the poorhouse if you get sick,
but not for anything <a
like prescription drugs.
- Speaking of drugs, nothing about the state bulk-purchasing drugs
to get lower prices. (There’s <a
bill to deal with that.)
- Cost-control is simply not dealt with. Nothing about a
best-practices research organization, which was originally a part of
the Senate plan. Too bad; such a thing might make MA a real leader in knowing what we’re doing with our health care dollar.
- Re-insurance, in which the state would take over catastrophic
care costs, apparently went out the window. Last I heard it seemed to
be working well in New York State, and it was originally a part of
Travaglini’s plan. It definitely would have led to lower premiums,
although it would have been expensive for the state. I suspect that
this went out with Romney’s insistence that the whole thing be
Bottom line? Health care reform isn’t finished, not by any
stretch. What we have here is a framework; what’s most critical now is
to figure out how to get care for the vulnerable people just above the
subsidy levels; and how to control costs in the system at large.
By the way, check out <a
post from John McDonough and <a
post from “Differently Winged” Bruce at mAss Backwards; aside from
the general tone, you’ll find they share areas of concern.