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

States and Pres Candidates Wrestle on Health Care

States and Pres Candidates Wrestle on Health Care

July 11, 2007

Two important articles in national papers today on health reform: one on state health reform, and the other on the presidential campaign health conversation:

First, NYTimes -- click here -- covers the uncertain fate of Gov. Ed Rendell's ambitious health reform plan in Pennsylvania. Seems pretty close to "stick a fork in it, cuz it's all done" time:

... But hospitals are lobbying against his proposals to regulate expenditures for new construction and equipment and to cut off reimbursement payments when patient stays are extended because of medical mistakes and preventable infections. Doctors do not like his proposal to give more responsibility to physicians’ assistants and nurse midwives. Small-business owners are protesting his call for a “fair share assessment” — a 3 percent payroll tax on employers who do not offer insurance, with the proceeds dedicated to covering the uninsured. And insurers are working to defeat proposals that would prohibit consideration of preexisting medical conditions in rate-setting and require that at least 85 percent of premiums be spent on health care costs as opposed to administrative overhead.

The Senate remains in the hands of Republicans who side with hospital, insurance and business interests. In the House, Democrats are fighting to hold the single-seat majority they gained last November after 12 years in the minority. Neither chamber is in the mood to raise taxes, and Mr. Rendell’s “fair share assessment” has won little support. The governor has linked budget negotiations to some of his proposals, and the legislature is still considering them. But his broader plan has effectively been tabled until a fall session because of business opposition to the payroll tax.

Pennsylvania has never been a health reform state to my memory. Democrats in the House are nervous about their razor thin majority, and conservative Republicans who control the Senate are in no mood to play ball. Kudos to Rendell for trying, but this is a tough slog.

Meanwhile, the Washington Post -- click here -- reports in "Democrats Eyeing Health Care" that MIT economist and MA Connector Board Member Jonathan Gruber is the health care go-to guy for candidate John Edwards and others:

"Far be it for me to lecture you on politics, Senator Edwards," Jonathan Gruber recalled saying, and then he did just that. He told Edwards that whatever the merits of Emanuel's idea, it just would not be politically viable. Instead, Gruber argued for a more incremental approach, like the one in Massachusetts he helped write. Its central elements would be providing subsidies to people who are unable to pay for health care, increasing the number of those who are enrolled in public programs such as Medicaid and creating a public agency to help anyone ineligible for the programs buy health insurance.

The Dem candidates are struggling to be bold on health coverage without being too bold.