john mcdonough


Health Reformer’s Red Past Revealed!

Harvard professor and author John E. McDonough

Help! I seem to have entered a time warp to the McCarthy era! Or maybe a wormhole back into the Cold War!

Some sort of Red Scare nightmare? No, I’m just in a state of bafflement after reading “The Socialist Behind Romneycare.” Posted by the right-wing group Accuracy in Academia, it targets Harvard School of Public Health professor John McDonough, who was involved in building both Massachusetts and national health reform and is the author of “Inside National Health Reform.” (Also, these days, the Health Stew blogger for the Boston Globe.) The post reveals that (gasp!) more than thirty years ago, McDonough belonged to the Democratic Socialists of America and chaired its Boston chapter for a couple of years.

The post cites work by blogger and Communist-outer Trevor Loudon: “Loudon’s new report, which is potentially embarrassing to Mitt Romney as he tries to prove his conservative credentials, is headlined, “How DSA Marxists Influenced Health Policies for Both Major Presidential Candidates.”

Now, I know that living in Massachusetts distorts my vision and leaves me insensitive to the realities of national politics, and I know that I should never try to find true logic in political game-playing. But I can’t help asking: Could anybody, anywhere, really care anymore if a politician or a professor — or a health care reformer — once propounded socialism? The Cold War is over, Communism couldn’t be deader, “Are you now, or have you ever been, a member of the Communist party?” has become synonymous with McCarthy-era abuses. And if Mitt Romney praises the Israeli health system, is it some sign of pernicious socialist leanings that in his latest blog post, McDonough praises the French?

Prediction: MA Legislature Won’t Pass Health Reform Before Next Summer

Harvard professor and author John E. McDonough

I promise, this will be the last post from my recent conversation with John McDonough, Harvard School of Public Health professor and author of the new book, “Inside National Health Reform.” (With the 3-minute video and the top 10 ObamaCare list, you might think we’re aiming to do All McDonough All The Time.)

But his prediction about the coming course of Health Reform 2.0 in Massachusetts struck me as so savvy and grounded in historical experience that I just wanted to share it. Gov. Deval Patrick has been pushing for the legislature to move as soon as possible on his proposal to change how health care is paid for. Predictions from legislative leaders on when that might actually happen have included this fall and this spring. John, who was involved in the landmark 2006 reform expanding health insurance coverage statewide, notes:

“I’ve observed — and this goes back to 1995, since the legislature made the profound procedural change of going to two-year sessions — that just about every major health care bill, every piece of legislation on health care reform — has reached the governor’s desk in June or July of the even-numbered year.” [The one exception, he noted, was the major 2006 reform, which passed in April, but that was because of pressure from a federal deadline.]

“It has to reach the point in time where the legislature has the sense of, ‘Uh oh, if we don’t do something, we will be judged as a general court to have failed to meet one of our responsibilities.’ But it really does take the deadline for the forces to come together and make something happen. We had reform in 2010, 2008, 2006, and when I was in the legislature, it was 1996.”

The 3-Minute ObamaCare Soundbite Challenge

John McDonough has written a definitive book on the Affordable Care Act of 2010, better known as ObamaCare; he was intimately involved in its creation; and he probably knows the 800-plus-page law as well as anyone alive. But could he handle the 3-minute challenge?

I figure the typical human response to talk of the complexity and enormity of the 18-month-old federal health reform law is for the brain to shut down within three minutes. So that’s the limit I gave John, a professor at the Harvard School of Public Health, for explaining what’s most important to know about what’s happening with national health reform now. My favorite line: “As a result [of the law], there is probably more innovation and change going on in our health care system than in anyone’s living memory.”

‘As a result [of the law], there is probably more innovation and change going on in our health care system than in anyone’s living memory.’

I’d like to pretend that he just didn’t quite make it in three minutes, but in fact, my Flip camera inexplicably shut down at just about the three-minute mark (no wonder they were discontinued), so below is what he would have said if not so rudely interrupted:

…and because the law is a landmark law, that really can only be legitimately contrasted with the 1935 Social Security Act and the 1965 Medicaid and Medicare act, it is a landmark law that is replete with numerous smaller landmarks in there, including on elder justice — a whole new  national framework addressing abuse and exploitation of seniors — and the Indian Health Reauthorization Act to modernize the Indian Health Service.

There are so many examples people have no idea are in there — calorie labeling in restaurants — there’s just so much here. What I find as I talk about this around the country is that everybody  has an opinion about the law, everybody has their mind made up, and almost nobody has a broad understanding of what the law is and what it does.

So what I try to do in the book is help people understand the law’s essential broad architecture to get a sense of the whole. Because everybody’s heard of calorie labeling, the individual mandate, lifetime benefit limits, but people lack a sense of the whole scope and ambition of the law. And not in a way to say you should love it or hate it, but you should, if you can, try to understand it, particularly with the stakes so high leading up to Nov. 6, 2012.

The book, “Inside National Health Reform,” is garnering rave reviews, including here on the Incidental Economist blog. The blog’s Austin Frakt describes the book as a great mix of spinach and sugar, which might be bad culinarily but works well intellectually:

As you can no doubt tell from my recent posts, I found a lot to like in John McDonough’s Inside National Health Reform.* I’ve now read the whole thing.

It’s really two books in one. The first is the story of the politics of getting to reform. The second is the story of the law itself, what it says and what it means. I’ll bet you’re thinking the first part is (political) mind candy, the second spinach. You’re half right. McDonough was (is) a true insider, having served as senior adviser to the Senate Committee on Health, Education, Labor and Pensions, which granted him access to many crucial meetings and key individuals. He put his inside knowledge to use in the first part of the book, where you’ll find many of the quotes I posted while reading. Continue reading