federal health care reform


Book: ‘Great Experiment’ Of Mass. Reform Should Not Go National

In Democrat-dominated, famously liberal Massachusetts, the Pioneer Institute is a downright dissident voice. It is an independent non-profit that believes in “rigorous, data-driven” thinking and backs “free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government” — in short, it is that rare Massachusetts institution that leans right.

In discussions about health reform, the Pioneer Institute arguments often challenge the state’s party line. Such as, for example, that Massachusetts reform is such a clear success that it can serve as a model for the rest of the country. The Pioneer Institute regularly shares its health-reform arguments on its blog and elsewhere (including valuable comments on CommonHealth), and has just come out with a book: “The Great Experiment: the States, the Feds and Your Healthcare.”

I spoke today with Josh Archambault, the Pioneer Institute’s director of health care policy and one of the book’s co-authors, and shamelessly pressed him to simplify the book’s arguments — which are already well simplified in the text — into even smaller soundbites. He kindly obliges here — and also allowed us to share graphics worth a thousand words. Our conversation, lightly edited:

So how would you sum up the central argument of the book?

Josh Archambault

There are two: The first one stems from a frustration with the national dialogue on health reform and how little state perspectives have been part of that discourse. So we have laid out a blueprint of how we believe we should move forward in resetting the state and federal relationship on health reform. From our perspective, we would like to see states have a lot more flexibility in how they tackle the health challenges they face.

The second one revolves around Massachusetts, which is that during this presidential debate season we’ve seen a number of “experts” arise that aren’t fully informed about the history and the current state of play in our state. And we wanted to put in one location the latest data, and a concise history of what happened during the debate and what has happened during implementation.

 In chapter 6, it sounds like what you’re arguing is that what began as Romneycare was effectively subverted by the Patrick administrations that followed. What is that story?

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The Colonoscopy Switcheroo: Quirks Of ‘Free’ Preventive Care

Arelis Gomes points out the free preventive care information in her Health Care for All brochure.

Don’t miss today’s incisive report by WBUR’s Martha Bebinger on when free preventive care is not free preventive care. That is, the federal health overhaul aimed to make much preventive care free, from check-ups to screening tests, but that’s not always how it plays out in practice. And sometimes you only find out when you get the bill or are asked for the co-pay.

The Web version is here and the full script is below, but I just wanted to highlight the part that really blows my mind: As one Massachusetts woman was horrified to discover, it’s possible to go in for a free — because it’s preventive — colonoscopy, but then while you’re still on the table, if the doctor finds polyps and removes them, that transforms it into a non-preventive — and thus billable to you — “surgical procedure.” Not to pick nits, but doesn’t polyp removal prevent colon cancer?

WBUR's Martha Bebinger

We have a story you might want to file under Consumer Beware. The new federal health care law makes dozens of preventive tests free for patients. Doctors or hospitals are not supposed to charge patients anything for an annual check-up, most screening tests and a dozen other services such as tobacco. This provision of the law began taking effect, as you renewed your coverage, more than a year ago. But as WBUR’s Martha Bebinger reports…there is still confusion about how it works.

Arelis Gomes, an outreach coordinator for the consumer group, Health Care for All, spends her days deciphering and explaining the federal Affordable Care Act or ACA. For more than a year now, she’s been telling consumers that they will no longer have to pay anything for preventive care. So Gomes says she couldn’t believe it when she arrived a few weeks ago for her annual check-up and the receptionist asked Gomes for her co-pay. Continue reading

Mitt Romney On Mass. Health Reform: No Apologies, But Not For Everyone

I’m a little snow-addled, so I didn’t quite get the gist of what former Massachusetts governor Mitt Romney was saying yesterday, but I think I do now, with some help from Politico.com’s Ben Smith here.

During last year’s debate, Romney struggled to distinguish the Massachusetts plan, which his spokesman called his “signature” accomplishment as governor — with its exchange, mandates, and subsidies — from a federal plan that shared its policy pedigree and had obviously been constructed along the same lines.

One of Romney’s weak arguments was that the Massachusetts plan was fundamentally different, as a matter of policy, because it had been enacted on a state rather than federal level. The argument got little traction and Romney, after an effort in the Spring of 2010 to explain his record, simply fell silent.

Romney’s argument is now much stronger. Because the main objection to ObamaCare, as its critics call it, is no longer a matter of policy nuance. Now critics primarily make the case that it’s an unconstitutional expansion of specifically federal power. And on that turf, the similar structure of the plans doesn’t matter. Romney enacted his at a state level, and states have — conservatives argue — more power to regulate the insurance industry, as they do with car insurance.

Background: Many think that Mitt Romney’s prominent role in Massachusetts health care reform will prove a liability for him among Republican voters in his next presidential run. Voters who don’t like the federal health reform, which is partly modeled on what he helped wreak in Massachusetts, could turn against him.

But yesterday, on the talk show circuit, Romney portrayed the issue as one of states’ rights: The Massachusetts reform — extending near-universal health care access and requiring almost everyone to have insurance — works here, but that doesn’t mean the federal government should impose it on other states. In a couple of nutshells: Continue reading

Florida Judge: The Government Could Make You Eat Your Broccoli

As the pundits parse yesterday’s Florida court decision striking down federal health care reform, I particularly enjoyed this sharply argued piece in the Washington Post, which attacks Judge Roger Vinson’s broccoli argument:

Vinson adopts the conservative thought experiment that the individual mandate could lead to the government forcing you to eat your vegetables. “Congress could require that people buy and consume broccoli at regular intervals,” Vinson writes, because “people who eat healthier tend to be healthier, and are thus more productive and put less of a strain on the health care system.”

This is meant to be a clever response to the idea that the health insurance market has particular qualities that justify the mandate. The only problem is that the argument doesn’t track — food is not like health insurance because waiting until you’re starving to eat doesn’t make the price of potatoes go up for everyone else. To borrow an argument made by Alex Koppelman, taxpayers already foot the bill for agriculture subsidies that manipulate us into buying cheaper, unhealthier food.