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

Should Obama Pursue Comprehensive Reform?

Should Obama Pursue Comprehensive Reform?

September 29, 2008

In Friday's debate, the candidates were asked what programs or priorities they would have to give up because of the cost of the financial rescue. Neither candidate really answered, but instead each talked about what they wouldn't give up. For Obama, one of the priorities that he would insist on was health reform:

We have to fix our health care system, which is putting an enormous burden on families. Just -- a report just came out that the average deductible went up 30 percent on American families.

They are getting crushed, and many of them are going bankrupt as a consequence of health care. I'm meeting folks all over the country. We have to do that now, because it will actually make our businesses and our families better off.

The moderator tried again to get the candidates to list something they would drop or defer, and Obama again said healthcare was essential:

The only point I want to make is this, that in order to make the tough decisions we have to know what our values are and who we're fighting for and our priorities and if we are spending $300 billion on tax cuts for people who don't need them and weren't even asking for them, and we are leaving out health care which is crushing on people all across the country, then I think we have made a bad decision and I want to make sure we're not shortchanging our long term priorities.

Well, Henry Aaron, a old hand at health policy, has written a provocative piece for The New Republic arguing against pursuing comprehensive reform. Obama shouldn't go for the big enchilada, Aaron says, because it's unlikely to succeed, and failure would cause devastating political fallout. Instead, he makes four recommendations, three of them which build on what Massachusetts is already doing:

  1. expand SCHIP to cover almost all kids (we're already there);
  2. test the effectiveness of treatments to see what's cost effective;
  3. encourage states to pursue their own reform plans. Here he's very positive on MA health reform: "Today, only Massachusetts has a comprehensive plan to extend coverage to the uninsured. Massachusetts is confronting--and, at least so far, solving--financial and administrative problems that any national program must address. If the federal government encouraged such state efforts, including some financial protection during economic slowdowns when state revenues drop and health spending does not, additional states would take the plunge, helping to pave the way for national legislation.
  4. Create a national "Connector." Aaron links to the MA Connector site and praises the ability to do comparison shopping there.

Meanwhile, more details have emerged on Senator Kennedy's effort to build a consensus plan in Congress now, to be ready by January. Kiplinger's has the story, here, which says the bill may include cost and quality measures as well as access reforms.
Brian Rosman