The Massachussets Model

The New Republic has an interesting article by Jonathan Cohn called Going Dutch: Life After the Public Option, which suggests a possible solution to the U.S. health care disaster that does not require the public option, a more and more unlikely component of health care reform after today's vote of rejection by the Senate Financial Committee.

Cohn's article looks at the way the Netherlands have solved the health care conundrum for their people and suggests that it might be a model for the United States to follow. However, it neglects to mention one important fact: The closest the United States has come to date to implementing the Dutch model is the health care reform adopted by Massachusetts just a few years ago, which did not go far enough because it lacked the will to do what the Dutch system does: strictly regulating insurers.

The current against government regulations in the United States is so strong, even among some Democrats, that any suggestion of government regulation is met with cries of socialism even in areas that are completely non-controversial in the rest of the world, like consumer and environmental protections. For that reason, and that reason alone, we should be very skeptical of any reform which rests on the ghost of future regulation as an acceptable substitute for concrete government intervention.

In an op-ed written earlier this year for the Boston Globe, Susan Kin--a practicing physician--sums up the results of the Massachusetts refom with the title Mass. healthcare reform is failing us.

According to Dr. King's article, the Massachusetts model, which is often cited by some conservatives as a preferable alternative to a "government-run" health care system, has a number of flaws that clash against the criteria for good health care identified by the Institute of Medicine, which is part of the National Academy of Sciences. Some of the flaws are:

• It has not achieved universal healthcare, although the reform has been a boon to the private insurance industry
  
• The program is not affordable for many individuals and families
  
• Costs are too high for even skimpy coverage
  
• Spending for the Commonwealth Care subsidized program has doubled
  
• additional out-of-pocket expenses can result in many people not using their insurance when they are sick

The way things are playing out on Capitol Hill shows that one of the goals of reform opponents (perhaps their single most important goal) is to trick Democrats into passing a much weakened bill by themselves, without any Republican support, one that is set up to fail. A bill that resembles much too closely the Massachusetts model.

If Democrats insist on trying to dilute the substantive elements of health care reform for the sake of unattainable bipartisanship and to appease the more moderate or downright conservative elements in their party, they will end up passing a bill that will fail to achieve universal coverage, will do nothing to contain costs, and will represent another massive giveaway to insurance and pharmaceutical companies. The damage done by such a bill will far exceed the good accomplished by it, and Democrats, including the conservative Democrats who are doing all they can to sabotage real health care reform, will end up paying in 2010 and beyond. And deservedly so.