Washington Post blogger and columnist Ezra Klein again masterfully explains the lessons of Massachusetts health reform – politics and substance – in the national context. From his latest column:
The health-reform bill President Obama signed into law this year was explicitly based on the Massachusetts reforms. The theory was this: A plan that a Republican governor could sign into law would be a plan that could attract Republican votes.
The theory was wrong. An approach to universal coverage that represented “health insurance for everyone without a government takeover” when it was signed by a Republican governor in Massachusetts was spun by congressional Republicans as the missing final chapter of “The Communist Manifesto” when Democrats tried to scale it nationally.
Given that the plan was enacted anyway, it’s time to check in on how Massachusetts is doing. And the answer, basically, is pretty well. This week, the state’s health and human services agency released the results of a new, independent survey examining coverage in Massachusetts. More than 98 percent – 98 percent! – of the state’s residents now have health insurance, as do more than 99 percent of the state’s children.
Remarkably, those numbers have gotten better in recent years, with the number of uninsured residents in the state falling to 1.9 percent in 2010 from 2.6 percent in 2008. That’s very unusual. Normally, the ranks of the uninsured swell during recessions as people lose their jobs and states cut back on public programs to balance their budgets. Nationally, the number of Americans who are uninsured rose to 16.76 percent in 2010 from 14.8 percent in 2008, according to Gallup.
Klein acknowledges the continued cost problems in Massachusetts, and notes that the federal law provides some tools that can address costs:
All is not roses and waterlilies for Massachusetts, of course. The reforms didn’t address a number of problems: The state had, on average, the highest health-care costs before reform, and it has the highest health-care costs today. (There are a variety of reasons for this, many of them having to do with the power of the state’s renowned hospitals.) Waiting rooms were overcrowded before, and they’re overcrowded today. And there are places where the reforms didn’t work as hoped. Predictions that expensive emergency room visits would drop now that people could go to the doctor have not been borne out.
The national law is better on at least some of those counts. It has provisions to expand the medical workforce, particularly the ranks of general practitioners. It has a slew of cost-control efforts, including a tax on expensive health insurance plans, an independent board able to make cost-cutting reforms to Medicare, a vast array of changes to the health-care delivery system, changes designed to get us away from paying for volume and toward paying for quality and much more.