can hardly belive it:
So, how well will health reform work after it passes?
There’s a part of me that can’t believe I’m asking that question. After all, serious health reform has long seemed like an impossible dream. And it could yet go all wrong.
So, will it work? Well, we don’t know what it is going to be yet, though the big shock right now is the apparent rebirth of the public option. Reid says it will be part of the vote on the floor, though apparently the 60 votes aren’t quite there yet.
But no-matter what we get — and Krugman rightly calls it a Rube Goldberg contraption, because there are so many moving parts — Krugman thins it will work.
[T]he experience in Massachusetts, which passed major health reform back in 2006, should dampen conservative hopes and soothe progressive fears.
Like the bill that will probably emerge from Congress, the Massachusetts reform mainly relies on a combination of regulation and subsidies to chivy a mostly private system into providing near-universal coverage. It is, to be frank, a bit of a Rube Goldberg device — a complicated way of achieving something that could have been done much more simply with a Medicare-type program. Yet it has gone a long way toward achieving the goal of health insurance for all, although it’s not quite there: according to state estimates, only 2.6 per cent of residents remain uninsured.
Well, yes. The push towards more universal coverage has been successful.
But that’s not the only goal of healthcare reform: there’s also cost or bending the curve down, as they say. And on this, the Massachusetts record is anything but a slam dunk. The New York Times notes in March that after three years of the program, costs already looked to be unsustainable, barring a massive change in how hospitals were compensated.
The LA Times discussed it more recently, and the commentary should be ominous:
But insurance premiums for most residents are going up, not down. Many middle-class people who had insurance before the overhaul see little change — except that they’re spending more. They’re seeing little or no difference in the quality of their care.
In crafting their plan, Massachusetts lawmakers ducked the tough issues of cost control, including how much public and private insurers would pay physicians and hospitals. So the state still has some of the most expensive medical care in the U.S. And costs are rising faster than the national average. Far faster than wages too.
“What we did was health insurance reform, not healthcare reform,” said Massachusetts state Sen. James Eldridge, a Democrat who regrets having voted for the bill.
This is exactly right. Actual healthcare reform would seriously attempt to get at the issues causing the delivery (or supply) of healthcare to be so expensive. Instead, we’re just looking at how its paid for, and hoping that will somehow work.
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