Health policy writers seem to be filling the lull between passage of a House bill and Senate Majority Leader Harry Reid bringing forward some as-yet-not-fully-defined legislation by writing about the Massachusetts experiment that has been underway since 2006. That state has greatly increasing nominal insurance coverage, reaching almost all residents, though a Kaiser Family Foundation assessment from September 2009 reports that 21 percent of insured people still don't feel they can afford medical care. And the wonks applaud it even though Massachusetts has not succeeded in lowering costs, either in the form of insurance premiums paid by individuals or to the state.
But Ezra Klein at the Washington Post and Jonathan Cohn at the New Republic are fans of the Massachusetts effort -- and they highlight one very similar observation. Klein, interviewing Jon Gruber, a health economist at MIT, elicited this quote:
Cohn makes the same point in his own voice.
I read both of these men to mean, more or less, that the good thing about passing some sort of health care reform structure is that it will shut up those annoying idealists who think health care is a human right and simply a proper benefit of living in a wealthy, civilized society. A coverage reform would get these bleeding hearts on to the serious business of controlling costs -- without the baggage of their fantastic egalitarian policy prescriptions.
I find this galling as policy prescriptions for controlling costs doesn't look so hard to imagine when a right to health care is assumed: simply make the government the payer for all health care and pay what the society decides democratically to allocate to health. We'd probably be willing to go for 15 percent of the government's tax income and that's a lot. Some variant of this is what every other developed country does, one way or another. There are still doctors and hospitals in those countries -- they just don't make mega-bucks.
For a more skeptical consideration of the Massachusetts plan, Cohn pointed to an extensive series in the Columbia Journalism Review by Trudy Lieberman. That reporter had this to say about what the state plan implies about cost control:
She doesn't want to rein in the idealists -- she just looks for the shortest distant between two points. If the government needs money, tax someone who can pay to raise it. Taxes are the price we pay for living in a civilized society. A society that refuses to pay for its own welfare is well on the way to death. (I know, I live in California which works that way.) This posture strikes me as realistic, while elaborate schemes to cajole profit-seeking entities to moderate their profits seem the flights of fantasy in the health care discussion.
UPDATE: Jonathan Cohn has written me to protest that he has
I think I owe him an apology or at least an explanation. I write about health care reform out of an ongoing fear that the realities of people's experiences will get lost in the fog of policy and political claims and counter claims. Responsible citizenship, in my view, requires repeatedly getting back to what it like to live in this mess and also reiterating ethical imperatives. I often fear that "understanding health care reform" almost requires forgetting what we know experientially. I've worked hard enough on understanding reform that sometimes I fear I am doing that myself.
Cohn presented the horrible present realities in his 2007 book, Sick.