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

USA Today Examines RomneyCare

USA Today Examines RomneyCare

July 5, 2005

Today's USA Today covers Gov. Romney's health insurance proposal that includes an "individual mandate" for individuals to purchase coverage or face state penalties: Mass. Gov. Romney's health care plan says everyone pays. Here are two key selections:

"Romney's plan comes as politicians, employers and benefit consulting firms are focused on the latest trend in health care cost control: 'personal responsibility.' ... It's a conservative idea," says Romney, "insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase."

Those who have followed this issue know we have real/practical reservations about Romney's plan: insufficient money to subsidize insurance for low/moderate income families, lack of financing/coverage details, faulty assumptions, incentives for employers to drop coverage, inappropriate cost sharing, and more. Yet let's consider the big picture:

"Personal Responsibility" is the conservative tonic for what ails the US health care system. While RomneyCare takes it a big step further, it's part of a larger pattern that assumes individual consumers are the problem, and cost sharing plus other financial burdens are the solution. Since each year, 80% of consumers are responsible for only 20% of medical spending, we reject this. We note that "employer responsibility" is not part of this vision at all as employers are left off the hook -- a happy convenience for conservatives.

Perhaps this is the start of a Nixon Goes To China moment in health policy -- a path to universal coverage that requires the embrace of an explicitly conservative agenda. Yet before the rest of the nation embraces this vision, they should remember it's only possible because Massachusetts already spends massive amounts on our safety net, resources that don't exist in most other states. And before we place our hard won safety net resources at risk for a plan with no details, we've got a lot more looking to do before we take this leap.

We've seen prior MA governors offer ambitious plans with great predictions: eg, in 1995 Gov. Bill Weld promised that his innovation, the Insurance Partnership, would cover 100,000 uninsured in year 1 and more than 250,000 in year 3 (today, in year 6, it covers about 14,000). Bill Weld, of course, never had to explain why he got it wrong -- his national ambitions took him far away from MA before any results could be tallied. Sound familiar?