Massachusetts vote a referendum on health care reform

January 20, 2010

Trudy Lieberman, a long-time health care and consumer journalist, is a contributing editor to the Columbia Journalism Review and has blogged about health care for cjr.org since the beginning of the presidential campaign. The views expressed are her own.

A few year’s back, a joke on the cocktail circuit went like this:  you know the world is  topsy-turvy when the best rapper is white; the best golfer is black, and the Germans don’t  want to go to war.  Tuesday’s vote in Massachusetts that sent Republican Scott Brown to the Senate taking over the seat held by Edward Kennedy for nearly fifty years produced a new twist to the old joke.

Things are indeed upside down when the advocates for a single-payer, national health insurance system supported a Republican.  On Sunday, one of those advocates, Diane Cooper Bridges, sent a letter to the president and to his adviser David Axelrod saying:

“Democrats are voting for Scott Brown b/c MA residents know for sure how  regressive and oppressive life is under the failed MA plan, especially in this recession that is not getting any better unless you are a banker or a broker on Wall Street or a member of the U.S. Congress.  And we know that the national bills are worse than the MA plan.”

For months a small band of single-payer supporters have tried to get the attention of their elected officials, telling them that their state’s much hailed health reform law, which became the model for the national bill Congress is crafting, was not working according to the official version that sometimes appeared in the nation’s news media.  For the most part, those people were dismissed.

Specifically, they wanted them to know that the premiums for insurance that residents are required to buy are too high and unaffordable for many.  Small businesses are hit particularly hard and are facing increases of 20 to 45 percent.  To make policies affordable, families are turning to high deductible plans which make them pay the first $2000 (or more) of their medical costs before the insurance policy does.  One person who recently dropped her policy after a 30 percent increase said what was the point of paying for a policy she could not use because of its high deductible.

Policyholders are gaming the system, buying insurance and using it for a few months to pay for care and then dropping it when they are well.  That raises the price of coverage for everyone, but it is an inevitable result of the kind of reform the state passed.

And a year after Attorney General Martha Coakley, who lost the election, began an investigation into possible collusion between the state’s biggest health care system and biggest insurance company that may have contributed to high premiums, no results have been forthcoming.   A Boston Globe reporter whose expose sparked the AG’s probe told me that some of the key players had not yet been questioned.

Even though polls showed support for the reform, a close look indicates that among people most affected by the law—those who had to change coverage or buy a policy—support was much weaker, a point often glossed over in national news reports. The public knew that the law called for no serious cost control, its most serious shortcoming also mirrored in the national legislation.

Throughout the last year, my blog posts about the Massachusetts health plan on cjr.org told of cracks in the state’s health care system and how people were pissed.  Yesterday the fractures opened wide; when people had a chance to vote, they expressed their dissatisfaction, which, of course, is what democracy is all about.  Americans also don’t like arrogant or imperious politicians, and they don’t care much for flim-flam.  Eventually they make that clear at the voting machine.

The vote was a referendum on health care reform.  A Republican polling firm that conducted an exit poll found that Brown’s opposition to congressional health care legislation was the most important ingredient in his victory.  Still, it seems like Washington is not hearing the message—at least not yet. Late last night House Speaker Nancy Pelosi said: “Massachusetts has health care and so the rest of the country would like to have that too.  So we don’t (think) a state that already has health care should determine whether the rest of the country should.”

And her number two man, House Majority Leader Steny Hoyer, noted:  “The Senate bill is better than nothing.”   The voters of Massachusetts seem to disagree.  The election results will no doubt now cause the rest of the country to check out the Massachusetts model and see if it is good for Mississippi.

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None of the respondents who claim to have experience of the health care system in Europe mention which part of Europe they know something about. “Europe” consists of more than a dozen countries, each with its own health care system. In some places, the health care is excellent, in some it is merely adequate. In all places, it is either completely free or genuinely affordable and, most importantly, available to all. And there is always the option of ‘private health care’ – i.e. doctors and hospitals outside the national system that you simply pay for yourself if you can afford it and do not wish to rely on the health care that is provided free. Likewise, there are private health insurance companies similar to those in the USA if you prefer not to rely on the universal national health insurance schemes that pay for the ‘free’ care.

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