Massachusetts

This week, Senate Finance chair Max Baucus released his preliminary outline of an eventual health care bill. This is significant because the Finance Committee spends the money, and that Max Baucus is not Ted Kennedy, who chairs the Health Education Labor and Pensions committee. So it indicates a degree of cooperation in the Senate that was lacking in 1994.

Ezra guides us through the plan. These things may seem familiar to Massachusetts residents!

• Pay or play for large/mid-size employers: Offer insurance to employees or give money to a pool for the uninsured.
• Pool together individuals and small groups; create an entity called the Connector the Health Insurance Exchange where such folks can easily compare plans.
• Personal mandate; subsidies for folks making <400% of poverty level. (In MA it's 300%.)
• Outlaw exclusions for pre-existing conditions (guaranteed issue).

It also calls for a federal Comparative Effectiveness Research Institute, which would give the marketplace unbiased research on the relative effectiveness of various treatments. Considering how much in health care is left up to the folkways of physicians, and not hard data, this is a most welcome suggestion.

The big big difference may please single-payer folks: A federal alternative to private insurance. That is, you can buy into a federal plan that works in direct competition with the private plans.

Now, the insurance industry won't like this. And in their lobbying, they will try to strip this out, or make it as crappy as possible so that it gets a bad name and becomes the insurer of last resort. But it doesn't have to be this way. If enough people find it valuable, then it will become a cherished part of the federal government, something that genuinely makes people's lives better. That will surely mark a gut-check for Congress — but it's one of the most effective things they can do. If government does the job better, why shouldn't it?

Anyway, this is exciting stuff, and it's remarkable to see the essential unanimity between the Edwards, Clinton, Obama, and now Baucus plans — with the exception of the personal mandate, but maybe even that's not that big a deal.

The world apparently looks to the Massachusetts model as something that can potentially work. We know here that it's nohow ideal, that it still leaves us with spiraling costs, and that addressing the access problem doesn't solve the supply problem. But we're better off than we were, and we were already better off than most of the country.

I'll be continuing to dig into the Baucus white paper for how it addresses health care costs, since that's the part that goes way beyond the access problem to, well, the solvency of the federal budget itself. Fun fun.

This entry was posted on Tuesday, November 18th, 2008 at 8:37 am and is filed under News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.