An Unhealthy Compromise

Universal health care, of a sort, in Massachusetts

| April 13, 2006


As anyone without insurance will readily acknowledge, health care in the United States is insufficient at best, in crisis at worst. Yet, on a policy level, we have seen nothing but gridlock at both the state and federal levels. So when Massachusetts hastily passed its health care reform bill, all eyes turned to the tiny state with big ambitions.

The defining characteristic of the bill, politically, seems to be how nonpartisan it is. Nobody can agree on whether liberals or conservatives should be happy; indeed, it looks like both are. Consensus, if there is any on this issue, is that the measure is 'something to watch.'

Across the political spectrum, however, skeptics have been cropping up. While some casually declare that the bill is doomed to go the way of then-Gov. Michael Dukakis' 1980s failed attempt at universal health care coverage, others are offering substantive, and sharp, criticism.

The co-founders of Physicians for a National Health Program (PNHP) issued a statement on April 5 that points to a glitch in the math. The group claims that the number of uninsured used for the purposes of the bill (500,000) vastly underestimates the real number (748,000). Why the difference? The numbers come from two different studies, one conducted over the phone only in English and Spanish (500,000), and the other conducted door-to-door in many languages (748,000). According to the PNHP, the larger tally blows the plan's cost out of the water and makes it a failure waiting to happen.



More troubling, still, is an article in the alternative weekly The Phoenix from mid-March, before the bill was passed, that outlines whose interests the bill will likely represent. Present at the meetings were groups like the Massachusetts Taxpayers Association, a fiscally conservative watchdog group, and Blue Cross and Blue Shield of Massachusetts. As a Science Daily article points out, 'The health-insurance industry... lobbied heavily on behalf of the legislation.' The planning meetings were conducted in shotgun style, as $385 million in federal money was riding on the bill's completion. And as The Phoenix points out, the meetings also were secretive and low-income residents were not represented; small-government proponents, big business, and insurance lobbyists, however, were there in spades.

One aspect of the bill that business did not want included -- and was vetoed by Gov. Mitt Romney when he signed the bill on April 12 -- is a provision that essentially fines employers $295 per employee if they do not offer health care. With a buy-out like this, critics wonder if businesses could reasonably be expected to opt for providing health insurance. Kevin Drum, of Washington Monthly, however, seems to home in on the bill's most fundamental problem: '[It] doesn't do anything to address cost containment and doesn't do anything to make the system more efficient.' By not addressing this core problem with health care in the state, say Alan Sager and Deborah Socolar, Directors of the Health Reform Program at Boston University's School of Public Health, in an eMaxHealth article, 'This mandate throws financially struggling individuals into battle with health insurance agents, insurers, and caregivers.' Any plan that does not address this issue is either willfully ignorant or, as others have argued, a boon for insurance companies.