The Treatment

Response: Massachusetts Reform Is Not A Model.

Diane Archer is co-president of the Health Care for All Project, which is run by the Institute for America's Future. She's also the author of a report, about the results of health reforms in Massachusetts, that I criticized a few days ago. We asked her to respond and she has. Diane is also the founder and past president of the Center for Medicare Rights, where she got a close-up look at how American health insurance works. So it's worth taking her arguments seriously. --Jonathan Cohn 

Jonathan Cohn's post "Massachusetts Miracle--Or Catastrophe?" argues that the information in my recent report on Massachusetts reform is correct but its framing is too negative, adding that he is "a glass-half-full kind of guy."

Well, I'm a glass half full kind of gal, who has never let the perfect be the enemy of the good. But, I'm not interested in throwing good money after bad. As I see it, the Massachusetts plan is not only not a glass half full, it is a glass with enormous cracks that enables all we pour into it to seep out.

Massachusetts chose not to tackle the major cracks in our health care system: out-of-control health care costs and inadequate insurance coverage. Rather, Massachusetts decided to try to fill the leaky glass by making it easier for people to get health insurance.

So, yes, Massachusetts reform has insured more people, but largely by throwing money at our broken health care system. And, that's cosmetics-a short-lived expensive overlay that may make the glass look half full for the moment-not the overhaul that's needed if we are going to make sure everyone is guaranteed good affordable health care over the long-term.

Imagine, you are 30 years old, married, with an annual income of $35,000, seemingly invulnerable, and hit by a truck. What exactly will the Massachusetts plan do for you? The answer is who knows.

If your job offers coverage with a high deductible and copays, you may be forced into medical debt if you want to walk on both legs again. So too, if your job does not offer coverage and the state waived your obligation to buy a policy because it recognized that no policy available was affordable for you. If you lose your job and insurance after being hit by a truck, you have to wait six months to be eligible for a subsidy.

And if you bought the Young Adult plan in the Commonwealth Choice program, your health and financial well-being will depend on how much it costs to set your broken bones. With the Bronze plan, you will have to pay nearly $10,000 before you hit your annual out of pocket cap.

The odds of your facing these scenarios are small-about 5% of the population consumes almost 50% of health care dollars-but the very purpose of insurance is to protect you from unforeseen problems.

These scenarios reflect only the drawbacks of the Massachusetts system for working people earning over 300% of poverty who are ineligible for a subsidy. But even the people eligible for the subsidy-those the state has arguably helped the most-face problems.

With escalating health care costs, the State has had to cut benefits and shift more costs to people with low incomes. As costs continue to escalate, such dismantling of the gains achieved by Massachusetts reform is likely to continue.

So, can the state plug the leak in its health reform glass? Perhaps Blue Cross will change its ways and stop colluding with Partners HealthCare to drive up costs. Perhaps the State, which has never been able to drive down health care costs, will force the insurers and providers to reduce their rates, and get them to agree to allow independent experts to look at their patient data and see what value they are delivering for our premium dollar. Perhaps the economic crisis will end and the State will find more money to keep throwing into the glass even as it keeps leaking.

National reform has to do much better. It has to create a cost effective health care system that guarantees health security for everyone. One that works for the minority with high health care costs as well as the majority who hardly need any health care at all.

For that, we cannot rely exclusively on the states and the private health insurance industry. The federal government must drive innovation and rein in costs through a public health insurance option. As I note in my report:

In sharp contrast to Massachusetts, President Obama and Senator Baucus include a public health insurance plan option in their models for health care reform. It is an essential element for containing costs and guaranteeing access to quality, affordable health care. As the data show, a public health insurance plan choice in addition to private health plans, drives competition, reins in costs and promotes accountability in the private insurance and provider markets. A public insurance option is also critical as guaranteed backup coverage for people who lose or otherwise lack private coverage.

--Diane Archer

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