A Better Health Care Alternative?

Senator elect Scott Brown from Massachusetts is offering a different take on the health care issue.  Rather than trying a one size fits all, he argues that Massachusetts, which covers 98% of its citizens, should be put forth as a model.   The current reform effort, which has yielded a bill that essentially tries to cut costs by limiting disbursements, doesn’t deal with the real problem.  The health care system as we know it is unsustainable.   Anyone looking at the data and trends cannot deny that.   A lot of people think that as long as they’re covered things are OK — but that’s shutting ones’ eyes to reality.

The health care compromise reached in the Senate did not satisfy anyone.  I didn’t like it, but argued last month that it was the best possible given the realities of Washington DC, and it would be better to pass something and tweak it later than let health care reform die.    Commentators on the left and right disagreed, albeit for different reasons.

Scott Brown’s idea, however, is intriguing — and a sign of how he was able to defeat a Democrat in the state of Massachusetts.   He isn’t opposing health care reform, and certainly not giving into the “teaparty” rhetoric of some on the far right.   The fact he holds up his own state’s health care plan as a model is something many on the right probably find abhorrent.    But he is challenging the Democrats’ effort to create a single national plan.

I think Brown may be right.   I believe health care should be a right in advanced industrialized countries.   Every other advanced industrialized state has a system that covers everyone, provides quality care, and costs much less than ours.  Moreover, our current system is unsustainable, as prices keep spiraling upward.   Health insurance costs have gone up 120% since 1999 while average income has gone up only 34%.   Projections are the cost could double again within the next six years.   Moreover, many people have little or no coverage, depending on their position in society.  As the boomers retire, and as the country’s health weakens and addiction to prescription drugs grow, this will only get worse.   We can’t sustain our current system.  But we can’t agree on a national reform.

Yet the states in Europe are smaller than the US.  They do not need a bureaucracy or a network the size of ours, nor do they have such a diversity in conditions as we do from Maine to California to Mississippi to Wyoming.  In Germany or France they can have one system.   One system for the entire US may be a  pipe dream.   And, of course, it also appears to be politically out of reach.

There is a clear message in the vote last night in Massachusetts.   People want change, and they want the two parties to work together.   Talk to most from the Bay State, and Brown didn’t win because he came on like Glenn Beck or Rush Limbaugh.  Quite the contrary, he was complimentary to Obama, said he agreed we need health care reform, and staked in independent stance, willing to cooperate with Democrats.   That’s what people want.  They punished the GOP for its riding roughshod over the Democrats during the Bush years,  now they are punishing the Democrats for partisanship in Obama’s first term.   Regardless of which party is most to blame — the Republicans clearly didn’t reach out to work with Obama — the public is telling both parties work together.  Solve our problems.  Stop bickering like children.

Senator elect Brown’s idea of the federal government incentivizing state initiatives to create health care reform at the state level might have the capacity to not only bring substantive refrom, but could also bring Democrat and Republican together.    Any real reform needs to focus on improving our health (wellness programs, fight obesity, etc.), cutting overuse of prescription drugs, cutting benefits for operations that are unnecessary, limiting payment for operations that make little sense (extensive unnecessary surgery for an elderly person), and controlling prices.

It’s hard to imagine a federal program effectively achieving these goals.   But effective reform could conceivably happen through state initiatives, provided that the federal government helps state have the resources to do this, most obviously in re-directing federal tax money back to the states.   Moreover, states could develop different models, and we could compare how each model works — states could learn from each other.

So I retreat from the position that this plan is the best we can do — let’s pass it and tweak it — to an embrace of a new direction, one put forth by the Republican who won in Massachusetts yesterday.    Let’s shift from a big national universal reform, to an effort to create universal health care at the state level, with federal support.  Moreover, let’s make this the first big bi-partisan effort to help the country recover from over thirty years of political and economic mismanagement.

  1. #1 by Mike Lovell on January 20, 2010 - 18:12

    “…let’s pass it and tweak it — to an embrace of a new direction…”

    Wouldn’t it make more sense to tweak the bill or write up a new one as opposed to pass something idiotic merely for the sake of doing something?

    I mean, if you think about it…between 7 and 9/10ths of all bills passed only add more regulations and provisions, rather than repeal anything that might be insane within the respective bills. The government prefers to add-on than remove as a rule. I say we write up new reforms for healthcare, even if we pass smaller bills in a series of steps towards tweeking things to where they need to be. And I do think that portability has to be an issue considered seriously, since we heard that there is no competition currently according to our politicians on the pro-side of these bills, yet the government itself actually exempted the insurance industry from anti-trust laws creating the lack of competiton themselves.

    As for Massachusetts being the model for the nation, thats a questionable argument. Afterall, we heard deficit-neutral, savings over time, and all kinds of other highly debatable arguments when confronted with cost of the current bills the Senate and House passed respectively, yet Massachusett’s particular version of Universal healthcare continues to rise in costs above the estimates given, creating a bigger deficit within that program, requiring more money to be redirected to prop it up, which then cuts into other aspects of the budget.

    Obviously, the entirety of the subject is far more involved than I can ever get into with my limited amount of knowledge, so I apologize if half of what I say here sounds more like a talking point than actual conjecture.

    • #2 by classicliberal2 on January 20, 2010 - 23:01

      “Wouldn’t it make more sense to tweak the bill or write up a new one as opposed to pass something idiotic merely for the sake of doing something?”

      Yes, but what you’ve just outlined there has been the Obama approach from the beginning. As Rahm Emanuel put it, don’t worry about the liberals; just pass something, we’ll call it reform, and declare victory.

      “…we heard that there is no competition currently according to our politicians on the pro-side of these bills, yet the government itself actually exempted the insurance industry from anti-trust laws creating the lack of competiton themselves.”

      And the Senate bill, which is not going to be allowed to substantially change, stripped out the provisions that would have removed that exemption–it allows insurance companies to openly collude and price-fix.

      “As for Massachusetts being the model for the nation, thats a questionable argument.”

      Not really: Health care “reform” in Massachusetts has been an unmitigated disaster. Health care costs in the state, which were precipitously rising prior to “reform,” exploded: The state now has the most expensive health care in the nation, with the highest premiums. It now have 96% of its population covered, but the costs are ruinous on the population, while the insurance industry has been laughing all the way to the bank. Scott, you seem unaware that this IS the blueprint the U.S. Senate followed in its version of health care “reform”; they’re virtually identical, and their results would be, as well.

  2. #3 by Jeff Lees on January 21, 2010 - 01:24

    This healthcare issue has been such a disappointment. I was so enthusiastic when the democrats won congress, and they have royally screwed it up.

    I agree with you Scott, many people don’t like how the democrats have handled it so far. You seem more optimistic then I do about the prospects of getting real reform, but we will see. I hope our senators from Maine will be spearheading a bipartisan bill. It’s also sad that this issue is being addressed at such a bad economic time, but it needs to be addressed.

  3. #4 by notesalongthepath on January 22, 2010 - 23:08

    I like your perspective, Scott. I always understand issues better after I read your posts. But I don’t understand why this issue is so difficult to move forward on. Is it fear of loss of profits by those who benefit from the way things are? What is at the root of this problem?
    Pasm B

  4. #5 by Nancy B on January 22, 2010 - 23:24

    As a Bay State kid who spent Christmas break there, I both agree and disagree with the idea that Massachusetts people are sick of the bickering. But a great deal of Brown’s win came from a) the nature of his seat (Ted’s) and b) the vicious campaigning from Coakley’s side. From everyone I talked to, they sensed that Coakley didn’t do much to appeal to the voters as herself, but merely the person who would pass the health care plan and act, effectively, as Ted Kennedy. Once Scott Brown started campaigning as a viable option, and people started getting on his side, her campaign became wretched. Out of every paper one would pick up, ten or twelve leaflets would fall out discussing how much Scott Brown hates Ted Kennedy and how he wants to deny care for rape victims i.e. a lot of lying and hyperbole. I know, to a certain degree, that’s the nature of a political campaign. But when the voters know little about her as a candidate, she simply began to come off as abrasive.
    I think she thought there was no contest until the past month or so, and then upped the negative adds to an insane degree. However, since her campaigning was so weak in the beginning, the race felt like “Scott Brown” or “Not Scott Brown”.
    I am comforted by your perspective on his state-by-state health care planning; it does seem like a system which could conceivably alleviate pain and suffering over the long run. I am troubled by it for two reasons. One, the “pass-and-tweek” plan is effective not simply in that it is a step forward, but that actual families will benefit in times of extreme need for adjustments made to the health care system. This will not just help, but save real families from financial destitution or worse. If we keep considering different options and tweeking and tweeking and tweeking before anything is passed, then more and more families are struck with accident and disease while uninsured. Secondly, state-by-state reform put states more susceptible to corruption in a hell of a sticky situation. Not to say that this is an impossibility on the federal level, but at least with a strict nation-wide watchdog of a plan, it will prevent individual states to sneak in loopholes or tricky wording which would eventually allow insurance companies, not citizens, to reap the benefits of the reform.

    • #6 by Scott Erb on January 26, 2010 - 03:42

      Yeah, I agree that a lot of people would be helped by passing the plan that they had agreed to. But politics is the art of the possible, and there is a lot of money, lobbying power and political clout on the side to defeat it. I knew Brown was going to win when I read about how Coakley went to negative — when you go that negative that late, in a gaffe prone way, it’s a very clear sign you’re in trouble! Thanks for the Bay State perpsective!

  5. #7 by Michael Arnis on January 24, 2010 - 07:59


    I have a question about how to discuss our health care system from this point forward. First, indulge me in a summary of the health care bills — it matters to the question.

    The national health care bills lump ideas into two buckets: coverage and delivery of health care. We are quite familiar with the coverage issues: not denying people access to insurance (“guaranteed issue”), the public option, “exchanges” like Massachusetts’, not denying payment for medical conditions you have at the time of coverage (“pre-existing condition” clauses).

    The delivery of care is about going to doctors and hospitals. National reform is filled with pilot projects on payment reform, coordinating care for chronic illnesses, and digging into and resolving unusual variations in treatments and outcomes across communities and throughout the country.

    The U.S. health care system delivers care worse than any other western democracy. An average country is not even within our horizon. We are far from average in treating many cancers, nearly all chronic illnesses (especially diabetes), and deaths from illnesses that respond to treatment. We have concluded that our New York Yankees prices have allowed us to sweep the World Series. Yet, each September, the standings show us to be in the cellar.

    When our poor results come up in conversation, people dismiss them and often become offended. We believe we are the best and cannot comprehend being last — at anything.

    Do you have any thoughts on how a politician should discuss our failing delivery of care with the American public so that people are motivated to build a better health care system? Tom Daschle has come closest in articulating the problem (without scolding the public), its urgency, and his trust in America to leapfrog from worst to first (mainly by the pilot projects in the reform bills).

    Such a dialogue is needed to shift the health care debate to one of values. Senator-elect Brown won by “marketing the values” (to steal your phrase) of fiscal constraint and states rights. The health care dialogue needs to be grounded in values such as life, my life and your life, and do we respect our lives enough to demand a health care system that does not squander money and underperform but contributes to our health

    Thanks, Michael

    • #8 by Scott Erb on January 26, 2010 - 04:39

      I agree, Michael — it is frustrating how the dialogue gets framed in ways that often seem out of touch with reality. Most Americans seem to have bought the idea that we have the best health care system, that “socialized medicine” means long waits and poor care, and that if we do nothing things will be like they’ve always been, which for most people is OK. Part of it is correcting obvious falsehoods — European health care systems are very high quality, and have a variety of approaches. Most conservatives in Europe support them because of the value of life and the importance of health care.

      Part also is to find a way out of the kind of disregard people have for “other people’s problems.” There is a kind of abstraction really evident in people’s views on health care, they don’t really connect to how many people are hurt and how many families devastated by the problems in our current system. My wife is a CPA, and works at a hospital and is shocked and angered by the problems in the system and the inability of the politicians to come up with an answer. I wish I knew how to communicate this better — or how to stand up against a very well funded lobbying and PR machine.

  6. #9 by Person Who Should Know Better on January 25, 2010 - 15:32

    “Every other advanced industrialized state has a system that covers everyone, provides quality care, and costs much less than ours.”

    This is flat out wrong. There are MANY issues with ‘quality’ care in many of these states.

    • #10 by Scott Erb on January 25, 2010 - 15:35

      There are issues with every system, everywhere. However, even Conservatives in Europe would be loathe to give up their system for something like what the US has. We spend far more of our GDP, our life expectancy rates are lower, and we leave a lot of people uncovered. But the future is where the real problems will be seen. Insurance costs are rising dramatically and the system probably can’t survive the first retirements of the baby boomers. Those who say our system is better than those in Europe clearly haven’t studied European systems. They do vary — the British system is probably the worst, Germany and Switzerland have excellent and very popularly supported health care systems.

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