Thursday, May 10, 2007

Health care reform 2007 - the Massachusetts plan

The discussion begins again. Gawande begins with the assumption that we introduce a new plan without removing the existing system. It's a practical approach.
Curing the System - New York Times
Published: May 10, 2007

....Experts have offered half a dozen more rational ways to finance all this than the wretched one we have. But we cannot change everything at once without causing harm....

...Option 1 is a Massachusetts-style reform.... Enacted statewide last year, the law has four key components. It defines a guaranteed health plan that is now open to all legal residents without penalty for pre-existing conditions. Using public dollars, it has made the plan free to the poor and limited the cost to about 6 percent of income for families earning up to $52,000 a year. It requires all individuals to obtain insurance by year end. And it requires businesses with more than 10 employees to help cover insurance or pay into a state fund.

The reform gives everyone a responsibility. But it leaves untouched the majority with secure insurance while getting the rest covered. As a result, it has had strong public approval. Experience with delivering the new plan is accumulating. And best of all, it offers a mechanism that can absorb change. The guaranteed health plan may cover 5 percent of the state at first, but as job-based health care disintegrates, the plan can take in however many necessary...
The Massachusetts plan seems very much like the Clinton plan, or at least something that would evolve to it. The employer burden is interesting, I assume it's there so employers don't ditch health care coverage en masse.

The "shared responsibility" part sounds like a political slogan. In any event this is consistent with my prediction of how it will all turn out.