There has been increasing talk from critics about how the health care reform proposals making their way through Washington won't work as promised because they are similar to what happened in Massachusetts. A few readers alerted me to this Boston Herald columnist who is making just that case. Below are some of the reasons I believe his argument is overly-simplified and why it doesn't hold much water once really examined:
FIRST: This from The Boston Herald: "In Massachusetts, brokering the 2006 overhaul was such a delicate and years-long undertaking that the disparate interest groups - insurers, businesses, consumers, hospital and doctors organizations - all agreed to first tackle health coverage expansion and leave the cost question for a later date."
They did not focus on cost controls early on and knew it. Obama has been battling against unions -- his own base -- and others to keep in a key cost control: A tax on Cadillac insurance plans -- which don't make people healthier but drive up costs for everyone. Health care experts say it is one of the most effective ways to cut health care costs. Obama fought to keep it in -- against heavy push back from the liberals in the House -- but pushed back the time frame to implement it to 2018 as a compromise. That's something I wish he would have been able to implement sooner. So, again, in Mass., they knowingly did not push for cost-controls at the outset, something Obama is struggling to do. Imagine if he had GOP help -- enough Republican Senators and Congressman -- to push through the major tax on Cadillac plans sooner? The bill would be even stronger because it would cover the additional 31 million people while having a realistic shot at cutting costs in a major way. That's why he was pushing so hard for a bipartisan bill even as he angered those on the left.
SECOND: Kaiser has compared the current proposal to what Republicans wanted in 1993 instead of what the Clinton's were offering. They look really similar: http://www.kaiserhealthnews.org/Graphics/2010/022310-Bill-comparison.aspx
In other words, while critics keep looking to the flaws in Massachusetts, they ignore that what Obama is trying to do today is what Republicans wanted to do in the early 1990s. Why isn't the GOP championing a proposal they once pushed?
THREE: This is from Mitt Romney's new book:
“Our reforms in Massachusetts didn’t produce a perfect system, just one that was much better than what had been there before, and it taught us all valuable lessons on how to work collaboratively to reform health care.”
No one is claiming a perfect system will be created or has been created, but we are definitely saying things need to be better than they are now, especially with the way we are headed.
Before the reform in that state, hospital emergency rooms, etc., were being over run, costs were going to high because too many people didn't have health insurance. Though they made a mistake by not putting in cost controls early, they are covering tens of thousands of people who wouldn't have insurance. And because they passed comprehensive reform already, they don't have to start from scratch and are now being forced to push those cost-controls they failed to enact earlier. Without the reform already a reality, those cost-containment measures today would likely have no support. Now, they are forced to make things better. That's an argument in favor of moving forward with a flawed bill in Washington today -- because you have to start somewhere. Seven presidents have tried and failed to do this and we haven't even tried to fix a system that is worsening by the month in almost two decades. It would be foolhardy for us to wait any longer to get started.
FOUR: To reiterate: The difference between Massachusetts and the nation is that they have a foundation upon which to build an even better system, which they have begun to do, and the highest-in-the nation costs don't bite into their income as much as other states because they have a higher median income that most other places. Here's a Boston Herald story which explains what they have begun to do about the high costs -- some of the things Obama is trying to do at the beginning of this reform -- and the reasons for those higher costs: http://www.boston.com/news/health/articles/2009/08/22/bay_state_health_insurance_premiums_highest_in_country/
FIVE: Tom Daschle, the Democrat who would be leading this charge if not for his personal tax problems, said this in response to whether or not the Senate bill does enough to control costs: "I don't think that either version of the bill does enough. I look at this whole effort as having three components: insurance reform, payment reform and delivery reform. And all three components have cost containment elements in them. Not nearly as much as I'd like, but I think a lot of the building blocks are going to be in place. But you can't expect one bill to comprehensively deal with each one of these components to everyone’s satisfaction. I tell audiences all over the country, that if this passes I think we're on the 30-yard line, that we've got 70 yards to go to accommodate really significant change in the system, adequate enough to be able to say we've addressed cost, access and quality in a meaningful way."
Warren Buffett and others have said essentially the same thing, that there are cost controls but they'd really like more of them. I certainly believe if the GOP was serious about being bipartisan, those cost-controls would have been stronger because Obama could lose some of the liberal votes and pick up some Republican ones to replace them. Instead, they chose to not fully engage in this process, for philosophical and other reasons. The GOP can make this reform effort better from the start if they would seriously compromise.
SIX: There are roughly 45 or 47 million uninsured people in this country today, with an estimated 45,000 dying every year because of lack of insurance. That number is expected to grow to more than 50 million people in the coming years if we do nothing. The current proposal will insure an additional 31 million people -- saving thousands of lives every year. Why does that not make this reform bill a pro-life bill?
SEVEN: I am suspicious of the conclusions of anyone still using that term "Obamacare." Some have said I demonize the opposition. Maybe I do but certainly don't mean to and will try to watch my tone from here on out. But using that term says a lot in and of itself. The Boston columnist does a few other things I also find interesting. He said 85 percent of people are happy with their health insurance. Maybe he's suggesting nothing is really wrong with our system so we should just leave it alone. He left out a lot of other differences between what's going on in Washington and what happened in Massachusetts -- in addition to the early fight for cost-controls in Obama's proposal to the lack of cost-controls in his state -- but if he checked out the Democrats proposals, he would also notice that it includes multiple pilot programs to be launched throughout the country as part of this process. The ones that prove to be the most efficient and bring the highest-quality care, they will be expanded, those that don't do what's promised will be eliminated. There are several such provisions in these proposals to get at some of the stuff he's chiming in about. His complaint also illustrates something many health care industry experts have been screaming about -- doing this on a state-by-state basis is not the right way. States cut needed health services in down town times, precisely when they are needed the most, so the problem never really gets solved. Doing it on a macro level has a better chance of changing that dynamic. This guy's argument proves their point. And there are not just left-leaning folks who believe the president's proposal will do something massive to begin changing the system -- without this being a government-run or government-take-over of the health care system, which is something else this guy inaccurately wrote.
Let me reiterate a previous point: Most of the folks who are in favor of the current proposal do not believe it is perfect and we know that one of the best ways to contain costs is to heavily tax those unnecessary Cadillac plans and other specific cost-controls. The unions don't like the tax and wanted the president to take it out completely but he gave some and pushed back its full effect until 2018. He's also fighting to cut $500 billion of overpayments from Medicare -- something the GOP is amazingly objecting to -- and to begin a serious effort to ferret out fraud by increasing the number of cops on the beat and changing the way insurance is billed so fraud can be detected more easily.
The GOP obviously understands President Obama is not backing down, that reform is coming whether they like it or not. Shouldn't now be the time when they say, OK, we'll join you to get some of those cost-controls and other important measures in?
I'm hoping this is what's happening now: Maybe the GOP leaders are pushing hard to avoid a vote because they've been told by a few in their ranks that there is no way they will go down in history as voting against something that was so necessary, so the GOP leaders will do everything they can to stop the vote, but once they finally realize they can't, they will play ball at the very last minute and some of the cost-control and other needed measures will be added on a bipartisan vote. A guy can dream, can't he?
