The New Republic's Jon Cohn, one of the smartest health reform advocates working today and a journalist whom I greatly admire, has taken up the challenge of defending the Massachusetts health care reforms, which currently serve as a model for national reform proposals. One of the things I admire about Cohn is that, in part because he views the business of legislating as an ongoing process, he frequently admits the problems with what he supports.
But such admissions can be telling. Here, for example, is a list of points I compiled from his piece on MassCare:
- Both liberals and conservatives agree that "Massachusetts hasn't figured out a way to restrain the overall growth in health care costs. If national health care reform fares no better, the country could be in serious fiscal trouble."
- The system is not the single payer plan some liberals might prefer, but nevertheless constitutes "a large expansion of government, even by Massachusetts standards."
- Under the current system, "by law, anybody living in Massachusetts must obtain health insurance or face a penalty, which this year will be as much as $1,068."
- As it currently stands, "Massachusetts has the nation's highest premiums, at more than $13,000 a year for the average family policy."
- Insurance coverage in the state is now the highest in the nation, but "coverage by itself is meaningless if it doesn't translate into more access to medical care or less financial hardship because of medical bills. And there is evidence, mostly anecdotal, that some people are really struggling under the new scheme, either because it's tough to pay the insurance premiums or because, even with coverage, their medical bills are a burden."
- "Massachusetts reforms haven't brought down prices on the whole. In fact, premiums for people who get insurance through employers are rising a tad faster than they are in the country at large. If costs continue to skyrocket, the state's health care reforms will become unsustainable, requiring either large cuts or tax increases."
- When Massachusetts, which the article calls "the ObamaCare laboratory," enacted its reforms, "the goal was simply to expand coverage and, perhaps, deal with costs later."
In making the list above, I've obviously left out a number of points that Cohn makes in the system's favor (administrators are making a big push for new cost control measures; there's some evidence that fewer people are avoiding care due to lack of insurance). But while I've cut out what he believes is the good news about MassCare, I don't think I've quoted Cohn's piece out of context, or been misleading in the way I've presented any of his statements. Indeed, I'd encourage people to read the piece in its entirety for themselves. But if this is a defense of the Massachusetts reforms, imagine what an attack would look like.