Wednesday, March 31, 2010

The Right Kind of Political Rhetoric in Massachusetts

Against the background of overheated, duplicitous rhetoric from the Republican right/Tea Party set, a recent op-ed by Massachusetts State Senator Richard Moore, co-chair of the Joint Committee on Health Care Financing, shows what's needed to advance public learning and meaningful reform. It's his approach to policy that I want to praise, not the specific policy proposals themselves.

Senator Moore starts by identifying what Massachusetts has achieved (substantially improved access to insurance) and has not achieved (cost containment):
Massachusetts, based on our landmark health care reform efforts, has the highest rate of residents with health insurance in the country. However, it would be premature for any of us to raise the "Mission Accomplished" banner over the Golden Dome!

Our mission will not be accomplished until we can also proclaim that the health care that is delivered through that insurance lives up to our region's reputation for the highest quality care, while ending our reputation for the highest cost care and high cost of health insurance.
The policy proposal he endorses involve caps on insurance premiums and provider charges, and supports legislation proposed by Governor Deval Patrick that would create these caps (see here for the text of the Governor's proposal). Most economists see price caps as an ineffective approach that is often destructive to the wider economy. But at a time when (a) job creation is the top priority for the state, (b) small businesses are seen as the key source of new jobs, and (c) health insurance costs strangle small businesses, (d) Massachusetts is seeing a crescendo of calls for immediate action.

Here's how Senator Moore straddles the clash between wise health policy, which would not rely on price controls, and wise job creation policy, which would encourage small business:
The governor and the Senate have both proposed interim measures that would cap growth in provider costs and premium increases. Nobody has claimed that these are the best solutions, or that they are even sustainable as long-term solutions. In fact, such caps, over time, shift costs to other parts of our economy and reduce choice, sometimes compromising quality in the delivery of care. However, if we continue to force businesses to choose between paying for health care for their employees and keeping their doors open, Massachusetts will never see true economic recovery and job growth.
Moore then describes the newly instituted annual public hearings on price increases charged by doctors, hospitals and other providers and premium increases charged by health insurance companies. Unlike the Obama administration, which demonized insurers, and the Republicans, who demonized Obama, Moore takes a more balanced and nuanced approach. His aim is to increase public understanding of the drivers of health care cost increases as a basis for collaborative public action:
...we hope that all providers, which include acute care hospitals, physicians, skilled nursing facilities, pharmacies, allied health fields, and all payers, including insurance companies, health plans, government agencies, self-insured companies, and individual citizens, will work with state government to reduce the costs of care without sacrificing universal access or improvements in quality of care. Just as all health care stakeholders worked together to produce our landmark Massachusetts health reform law, we need to work together to improve quality and contain rising costs. Hopefully, we can be effective partners in achieving high quality health care at an affordable level for everyone in the commonwealth.
Now that the agony of getting federal legislation past the "just say no" Republicans, we can hope to see more thoughtful deliberation at the level of the states. Massachusetts is especially important. It provided the template for the national approach to expanding coverage. Now its job is to do the same for cost containment.

Thoughtful and civil contributions like this one from Senator Moore will foster that effort!

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