Health care: Simple needs, complex solutions
Posted: Monday, January 12, 2009 5:06 PM by Daily Nightly Editor
By Robert Bazell, NBC News Chief science correspondent
If the Obama Administration and Congress attempt to bring America closer to full health care coverage as promised, the conversation inevitably will focus on Massachusetts, the state that has made the boldest effort in the country toward that goal.
On Nightly News tonight we begin a two-part series on the Massachusetts experiment. And we must emphasize that it is indeed an experiment. No one can predict whether it will succeed. But according to a recent Harvard poll, the residents of the state are overwhelmingly satisfied.
As I noted in a report last week on the Obama plans, the details of health care reform can be mind-numbingly complex, but Americans want something simple: freedom from worry that they either lack good health coverage or might lose the coverage they have.
The Massachusetts program has already managed to lower the rate of uninsured in the state to 3.3 percent compared to the national average of 16 percent. Since it began two years ago, 440,000 formerly uninsured residents out of a total population of about 6.4 million have gained health care coverage.
The program managed to get passed in 2006 because then Republican Governor Mitt Romney and the Democratic legislature worked together to make it happen. It builds on the systems that were already in place, and rests on an concept of "shared responsibility." Employers with more than 10 workers must pay the state about $300 per worker if they don't offer health insurance and residents must pay a fine--up to $900 a year--if they don’t get some kind of health insurance.
To make it easier to buy private health insurance, Massachusetts expanded the Medicaid program, which in most places is available only to the poorest of the poor, and to those with low paying jobs on a sliding scale. Private insurance is easier to buy because of laws in the state standardizing health plans and prohibiting insurance companies from denying coverage because of preexisting conditions. Insurance companies are generally supportive of the law because it requires young, healthy people to buy health insurance along with everyone else. As a result, the companies are not just insuring the older, sicker population.
In my opinion, the main reason the Massachusetts experiment has succeeded as well as it has is that the Governor and the legislature hammered out the broad outline of the plan and its budget and then left the details to a board called the “Connector” (http://www.mahealthconnector.org/portal/site/connector/). The 10-member board has representatives from government, business, labor unions, insurance and other interests. Its job is to wade through the swamp of complicated decisions that are necessary to make the program function. If the Massachusetts government had tried to write every contingency into law, the plan would have failed. Interestingly President-elect Obama and future HHS Secretary Tom Daschle, who will head his health care reform effort, have both called for similar national boards to reform health care nationally. As I said, the details can be mind-numbingly complex. But the public’s need is very simple.
Click here to watch the related video report from NBC's Robert Bazell.
