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

A Pessimist's View of Prospects for National Health Reform

A Pessimist's View of Prospects for National Health Reform

February 6, 2008

If you missed it, don't miss Larry Brown's (Columbia University School of Public Health) pessimistic take on our nation's prospects for meaningful health reform in the 1/24/08 New England Journal of Medicine: The Amazing Noncollapsing U.S. Health Care System — Is Reform Finally at Hand? Money quote:

So, though deeply dysfunctional by most standards, the U.S. health care system remains disturbingly stable. That no one really likes it does not translate into the inevitability of real change. Because the system is unlikely to collapse from within, reformers' best hopes lie with shifts in public sentiment and the election of activist and reform-minded political leaders. Such shifts can happen, as they did with lasting consequences in 1932 and 1964. But big bangs do not guarantee comprehensive health care reforms. Franklin Roosevelt declined to include national health insurance in his package of New Deal programs. Lyndon Johnson won enactment of Medicare and Medicaid but declined to fight for universal coverage. Since 1968, U.S. social politics have proceeded largely to the right of center, and the health care reform ideas whose time seemed to have come in 1993 crashed dramatically.

Underestimating the system's resilience risks leading reform astray yet again, but what exactly should be done is far from clear. No one knows how to infuse moral urgency into the push for universal coverage, make the system's medical style markedly less expensive, and thrust reform to the top of the agenda for powerful interest groups. Careful reconnoitering of historical terrain yields no formulas for success but may at least reduce the prospects of déjà vu.

I can't help it. I'm an indefatigable optimist. But, it's good to pay attention to the pessimist's case.
John McDonough