Blue Mass Group

Reality-based commentary on politics.

MA the model, because everything is perfect here

By

The big fat above-the-fold story in the Globe today dealt with other states — and even the US Congress — looking to the Massachusetts health care law as a potential model for them.

You’d think they’d want to see how things shake out before they dive in. Really, the only thing that’s been accomplished so far is that 1. there is an actual law on the books that purports to be “universal coverage”, which was indeed a notable political accomplishment; and 2. with the MassHealth (Medicaid, IOW) expansion, more people have coverage through the state than before.

Well, I’m genuinely happy with #2. I’m cool with the state providing care even up to the point of single-payer, since it’s morally good to provide care for economically vulnerable folks, and actually more efficient than our private sector. So if the result of all this is that other states end up expanding their Medicaid rolls (at the expense of their Free Care Pools), fine with me. Yeah it costs money. It also saves money and lives, and stimulates the economy at the ground level, since folks are more productive then they would be without health care.

But I tend to doubt this will be the case in states that aren’t used to giving the working poor a bucket of warm spit. Trent Lott has indicated his enthusiasm: Do you think he’s into expanding Medicaid? Can you see Trent Lott supporting a fair employer mandate? The supposed three-legged stool of employer, state, and individual responsibility starts to totter…

But hey, on the other hand, if more states adopt the personal mandate, maybe we won’t have the outflow of young folks eager to escape it. You can run but you can’t hide. I’m not sure I like that rationalization.

What all the pols like about MA’s health care law has very little to do with the nuts and bolts of the actual policy. It has to do with the political perception that politicians can deliver on universal health care. But I don’t have any illusions that there’s going to be widespread agreement on the parts of the bill that I like. And I fear a repeat of Medicare Part D, which was used primarily as a method to drive business to pharma companies. Health insurance companies ought to be heavily regulated for efficiency and transparency; will that be the price the insurers are willing to pay for more business?

While mandates on someone are necessary to deal with the problem of “adverse selection” in health insurance, the personal mandate in our law is going to be the least popular part among the public, once folks are actually forced to buy insurance in July 2007. Then we’ll see if out-of-state lawmakers are still interested.

Please share widely!
fb-share-icon
Tweet
0

Comments

  1. Either other states will say “we want to do what Massachusetts did” or they will hold us up as a negative example. We can be the anti-Texas in a good way or a bad way. We are a testing ground as to whether Democrats deserve to govern.

    <

    p>
    So don’t eff it up.

      • That’s partially because the Left is not aggressive enough. Texas’ truly awful experience with preventing home owners from suing contractors, for example, a decidedly conservative initiative has gotten scant national press. And we don’t demonize their folks as much their folks demonize ours. If Thomas Schaller gets his way, you will be hearing a lot more about South Carolina.

      • I think we all recognize that national talk radio would be far less incendiary without frequent mention of Ted Kennedy, same-sex marriage, Harvard intellectuals, and Taxachusetts.  Confusing any of the above for a Massachusetts ‘model’ in politics is nothing but a brightness test for the dimmer bulbs on the marquee.

        <

        p>
        If you are talking about a Massachusetts model for health-care, do you believe the national opinion is mostly negative?

      • Conservatives would have to invent it.  Like any system whereby authority attempts to direct morality, there is a need for an “other” to point to as a cautionary tale and warning — whether it be Snowball the Pig or Cambridge, Mass.

        <

        p>
        If Massachusetts were a happily ignorant morass of simplicity and trust in God, then they’d spend more time targeting tax rates in California, marriage rules in Vermont, abortions in New York, etc.  The difference is that conservatives deal in perceptions of blue states while liberals deal in facts about America as a whole.

        • Florida’s proclivity for privitizing many of the functions of state government has lead to a rather unseemly relationship between state contracts and campaign donations — in fact, this is the downside of these contracts wherever they occur — but liberals just don’t tell stories very well. We’re so fact and statistics-ba…

          <

          p>
          Excuse me while I go off and complete a chi-squared test.

  2. Here’s a prior user post that provides a substantive comment to Charley’s post.  The below excerpt was cross-posted from Health Care For All’s blog of 12 Dec 2006

    <

    p>
    And as you read below, please keep in mind that one person’s “catching on” is another’s “poison spreading”.  This begs for a look beyond the rhetoric to some thoughtful reflection on these two very different descriptors of Massachusetts’ new health refom law.

    <

    p>
    (disclosure: when full measure is taken of the MA health reform law and in particular the “individual mandate” and its $25mil commonwealth connector Romney/Heritage Foundation contraption, I say, with a heavy heart, “poison”.  I guess I find it hard to see the triumph of a “political” achievement  when many people will still needlessly suffer and many will die prematurely for lack of health care while we all pay way too much for what we’re getting…)

    <

    p> 

    MA Health Reform Is Catching on: NJ, IL, CA

      News from three key states again demonstrates that MA-style health reform has legs. How long, how durable – yet to be determined. But legs it has.

      New Jersey lawmakers “are drawing up a proposal…

      Meanwhile, in Illinois a “state task force on Thursday recommended a far-reaching reform…

      Finally, from California, Kaiser’s George Halvorson and colleagues present a universal coverage plan for California – “We describe several subsidized benefit options…

      Each plan contains – individual and employer mandates along with subsidized coverage for uninsured with incomes below 300% fpl. Each plan acknowledges inspiration from the MA reform law. And each costs big new bucks.

      ——–

      One Response/Comment  1. working nurse Says: 12/13/06

      Hello???

      “Each plan acknowledges inspiration from the MA reform law. And each costs big new bucks.”

      The MA reform law is deeply deeply flawed. It is flawed in the wasteful cost-shifting financing mechanism policy it contains, and more importantly, it is grievously flawed in that it pushes health care further in the direction of being treated as a commodity to be sold in the commercial marketplace, rather than treating it as a public good. True universal health reform must be premised on a model of social insurance, not a model of for-profit sales.

      This is why knowledgable health reform experts and activists in the states of NJ, CA, and IL have pleaded “Please help us stop the Massachusetts poison from spreading to our state.”.

      The Mass. law rewards the wealthy power brokers who dominate the state’s insurance-medical-industrial complex at the expense of the people of the Commonwealth. Other MUCH MORE sensible and affordable reform plans do exist. The CA legislature passed a universal coverage bill this summer that would use a streamlined financing mechanism and a social insurance model. Gov Terminator vetoed it. The demand for affordable, sustainable helath coverage is building in CA and here in MA and will not be stopped. The Chap 58 law is but an expensive wasteful tragic detour.

      Learn more and join the movement for health care justice [and sensible affordable reforms] at http://www.MassCare…. and http://www.OneCareNo… please make sure you watch the new and incredible YouTube video at the OneCareNow link.

    <

    p>
    We can only hope that Deval Patrick and his new administration will promptly chart a course to put the state on track toward more sensible, affordable, and  person and community-centered health care reform. To read multiple in-depth analyses of the MA health law, whose authors’ hail from across the nation, visit the Alliance to Defend Health Care’s website.  A number of critiques are posted on the page about State Health Reform, as well as an additional scathing critique from a senior health policy analyst at Consumers Union that’s posted with a link on the Alliance homepage.

    <

    p>
    I’d also like to offer these additional resources on health reform: the MA Health Care Amendment site for folks that want to help it get its 2nd ConCon vote on Jan. 2nd, and a link for a national health reform resource that is doing great grassroots work on this issue, that’s the organization HealthCare-Now.org

  3. here’s today’s dose of health policy from Dr Don McCanne, a primary care doc/health policy expert who manages “Quote of teh Day”, a national health policy listserve.

    Today’s Topics:

      1. Would Europe’s health-care-for-all model work here?

    From: Don McCanne
    Subject: qotd: Would Europe’s health-care-for-all model work here?

    Would Europe’s health-care-for-all model work here?
    The Press-Enterprise, December 17, 2006

    The perspective of Don McCanne, senior health policy fellow, and
    Nicholas Skala, research associate, [Physicians for a National Health
    Program http://www.pnhp.org]:

    Cover everyone and use Medicare as a model

    Compared to other advanced nations, the United States spends far more
    on health care but achieves only mediocre results. Though the World
    Health Organization has ranked us first in spending, we are ranked
    37th in performance –well behind Canada and all Western European
    nations. What do these countries know that we don’t?

    Universal coverage is public policy in the rest of the industrialized
    world, but it is not in the United States. We leave nearly 47 million
    without any insurance at all. Even the insured are finding that
    increasingly inadequate private insurance policies are leaving them
    exposed to insurmountable costs.

    Although unheard-of in other nations, illness and medical bills
    contribute to half of personal bankruptcies here, and 75 percent of
    those with medical debt had coverage when they got sick.

    How do other nations insure everyone, protect their personal assets
    from medical debt and do it at a much lower cost than that of the
    United States? Although no two nations have identical programs, none
    has adopted the disorganized, wasteful, fragmented insurance payment
    system that we have in America.

    In nations such as the United Kingdom, the government owns the health-
    care delivery system, and it is the direct provider of care. Other
    nations use a social insurance model in which care is paid for either
    directly through the government or via tightly organized and
    regulated nonprofit companies, while doctors and hospitals remain
    independent.

    These social insurance programs cover everyone, protect against
    financial losses, more effectively pool risks and fund the entire
    system much more equitably than we do in the United States.

    This egalitarian social insurance model of other nations contrasts
    sharply with the market model of private plans that we have here.
    Private insurance companies erect massive bureaucracies for the
    purpose of fighting claims, issuing denials and screening out the
    sick from coverage.

    Their principal product is an excess of administrative services with
    its resulting headaches. Doctors, hospitals and businesses must react
    by employing armies of administrators to deal with this massive
    private bureaucracy.

    Health-care administration consumes a mind-boggling 31 percent of our
    health spending. Some $350 billion of this waste could be recovered
    and is enough to extend good coverage to all Americans. Americans are
    already paying for national health insurance — we just aren’t
    getting it. Two-thirds of our health-care system already is funded
    through the tax system.

    Although it works well for our armed forces and veterans, Americans
    may have difficulty accepting a government-operated medicine system
    similar to the U.K.’s. But we are already comfortable with the
    concept of social insurance: Our Medicare and Social Security
    programs are familiar examples.

    The public’s response to recent threats of privatization has shown
    just how protective we are of these programs, even though they are
    government programs. A national health-insurance system for the
    United States — in essence “Medicare for All” — would likewise be
    successful and popular.

    Medicare is not perfect. It requires continual oversight and
    maintenance. But with appropriate revisions, it can serve as an
    American model of comprehensive coverage for everyone.

    While making funding more equitable, the system can assure care will
    remain affordable. Even though the Europeans provided us with the
    health-policy science, we can take pride in the fact that Medicare is
    our own, made-in-America idea.

    http://www.pe.com/lo…
    PE_OpEd_Opinion_D_op_1217_mccanne_loc.c79484.html#

    The opposing view, “Beware massive costs, rationing, loss of
    freedom,” was written by Grace-Marie Turner of the Galen Institute
    and Robert E. Moffit of The Heritage Foundation. Their op-ed was not
    posted on The Press-Enterprise website, but an unedited version is
    available from Galen:
    http://www.galen.org…

    The opposing view that was posted on The Press-Enterprise website,
    “Government-run systems restrict care,” was written by Merrill
    Matthews of the Council for Affordable Health Insurance:
    http://www.pe.com/lo…
    PE_OpEd_Opinion_D_op_1217_matthews_loc.c79387.html

    Comment:  Would Europe’s health-care-for-all model work here? Since
    no two European nations have the same model, the question really is
    whether an insurance program that covers everyone would work in the
    United States. Since we already spend far more per capita on health
    care than the European nations, there is absolutely no doubt that a
    properly designed universal insurance program would work as a “health-
    care-for-all” model (or Medicare for All).

    Grace-Marie Turner, Robert Moffit, and, separately, Merrill Matthews
    didn’t answer that question, but, in their usual reframing of the
    debate, they changed the topic to rationing. So their question is
    whether the level of rationing that would take place in the United
    States would be so severe that we should not attempt to cover
    everyone with effective insurance. In their response they ignored two
    crucial points.

    Those European nations that have been attentive to capacity and have
    practiced queue management do not have significant problems with
    excessive queues. At our level of spending, there would be no need to
    ration reasonable, beneficial health services, though we should
    reduce funding for non-beneficial or detrimental services. But that
    is not rationing; that is value purchasing – a feature of well
    functioning health systems.

    The other point is that they remain silent on the nation with the
    worst rationing of all – the United States. We ration care for tens
    of millions of Americans based strictly on their ability to pay. A
    national health insurance program would eliminate that inhumane basis
    for rationing.

    In our debate over health care reform we don’t need more anecdotes
    about C-T scans for dogs, or ideological discussions about freedom to
    pay for your own health care. We need serious discussions about
    policies that will work.  Unless the opponents come up with something
    better than  national health insurance, they should get out of our
    way and let us heal our very, very sick system.

    <

    p>
    Anyone is welcome to sign up for Dr McCanne’s health policy listserve: To subscribe or unsubscribe via the World Wide Web, visit http://two.pairlist….

Archives