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Massachusetts health care — wonky, with a healthy dose of reality

DC (Mis)Uses MA

DC (Mis)Uses MA

March 23, 2009

In the national health reform conversations, Massachusetts health reform has become a sort of fun-house mirror, where people see different images reflecting the political points they want to make in the Washington discussion.

It illustrates how some progressives feel they must delegitimize what Massachusetts has done to make their case about national reform.

Why do they feel the need to turn their noses at 432,000 newly covered people? Isn't there a counter-approach, ie: Massachusetts has taken coverage further than any state in history AND national reform ought to go even further? Is it smart to create divisions where none need exist?

This is reflected in the ongoing back-and-forth started by an essay by Diane Archer, writing for the liberal think tank, Campaign For America's Future. The essay, "Massachusetts Health Reform: Near Universal Coverage, But No Cost Controls or Guarantee of Quality, Affordable Health Care for All," makes the point that Massachusetts health reform has been successful in covering most of the uninsured. But she criticizes chapter 58 for not including some of the key features progressive groups seek to include in national reform -- no cost control, no public plan option, no regulation of premiums, insufficient employer responsibility.

In response, The New Republic blogger Jonathan Cohen critiqued the framing of Archer's essay. If we focus on the half-empty part of the glass, we'll miss the key message of Massachusetts health reform, that comprehensive health reform is possible. He also pointed out the progress MA is making on payment reform and other cost issues.

Well, then Archer hit back hard, with a headstrong critique of the failings of chapter 58. This time, Archer dragged out many of the misleading or plain wrong points made by the single-payer crowd that would prefer nothing to any progress on coverage expansions. I responded in the comments, pointing out the errors in Archer's response, and my response drew a detailed comment from blogger Maggie Mahar, defending Archer's original points.

Today, Connector Board member Jonathan Gruber entered the discussion, writing a response to the response to the response to the response. In Massachusetts, We Got Reform Right: "... the issue is whether you look at this as glass half full or half-empty. The former approach is realistic. The second is idealistic, and runs the risk of missing the best chance at universal coverage we have had in at least fifteen years, if not longer. Despite her protestations to the contrary, Archer’s arguments are perhaps the classic illustration of letting the perfect be the enemy of the good." Gruber makes the point that we've frequently made, that coverage expansions could not have moved forward in Massachusetts had the cost control effort been included as well. Once the coverage expansions were in place, that opened up the room and political weight to make progress on cost issues.

In my mind, these discussions ought to be on two separate tracks. First, there's a conversation on how to improve chapter 58 and health care in Massachusetts. There's a lot of activity on this front, from legislative efforts to expand employer responsibility, to Connector Board members seeking to strengthen affordability protections, and the multiple venues where cost and delivery system issues are being debated.

Second is the battle in Washington to shape national health reform, where the "lessons of Massachusetts" are being wielded around to make or oppose certain points. Given the somewhat unique circumstances here, and the much bigger national stakes in DC, this conversation needs to be careful as to how much weight to put on the Massachusetts experience. We can be proud of our accomplishments, and what it means for national reform. But we shouldn't let analysis of Massachusetts reform short-circuit the national discussion.
Brian Rosman