Bad Massachusetts Health Care Plan in Bad Trouble

Well, the outcome predicted by progressive critics since the Massachusetts Chapter 58 health care "reform" plan was passed into law in 2006 is now getting closer and closer to becoming reality as the board of the Commonwealth Health Insurance Connector Authority voted to cut $115 million from the program's 2010 budget this week. These critics - backers of a single-payer universal health care plan at both the state and federal levels like MassCARE - said that the main beneficiaries of the plan were the insurance companies and that it would therefore be structurally incapable of ever covering all Massachusetts residents. They also, ironically, made the kind of cost-benefit arguments generally advanced by fiscal conservatives - pointing to major studies, one of which was commissioned by the Commonwealth in 2002 - that clearly demonstrated a single-payer system would be far more cost-effective than an expansion of Medicare or the kind of individually-based plan we ultimately got.

Before and after the plan was enacted, the critics pointed out that the state was pursuing a course that had no cost controls and did nothing to attempt to stem health care premiums that private insurance companies have been increasing virtually unchecked year after year. They further stated that basing a system that should be guaranteeing health care as a universal human right on a market-based system that forced individuals to buy overpriced private plans, penalized all but the poorest if they failed to do so, and mandated that the state pay insurers ruinous prices to offer minimal coverage to said poor residents - looting the existing, and fairly comprehensive, publicly-funded community hospital based free care system in the process to attempt to pay for it - was a very bad alternative to a single-payer system that pushed private insurers out of the picture and paid for all health care costs out of a single taxpayer-funded government pool.

Now chickens are coming home to roost all over the place as the state budget continues its collapse - with nowhere to go but down given the decision to raise regressive sales taxes instead of instituting progressive taxation. Unregulated health costs continue to skyrocket as insurers buy political cover with billions in ill-gotten profits. Tens of thousands of Massachusetts residents never received any coverage at all under the new system, and now tens of thousands of other residents are about to join them in the ranks of the uninsured thanks to this week's cuts. The community health system - exemplified by the ailing Cambridge Health Alliance - is in deep crisis as its funding has been raided repeatedly to pay for the new system and is in no condition to take up legions of new patients.

And no real help is coming from the current federal administration whose health care agenda is as entirely driven by the private insurers as the last administration was. Maybe more.

For the moment, most progressive health care advocates are not engaged in fighting for a single-payer health care system on the state or federal levels, but instead have chosen the easier path of trying to improve existing systems as much as they can.

As I've said before in relation to tax policy in Massachusetts, I think this is a weak strategy and one worthy of reconsideration by progressive advocates.

In the run up to the 2006 reform, and in its aftermath, this kind of strategy was pursued by the MassACT Coalition among others. Now, as the state plan founders and the national health care debate is heating up again, Massachusetts members of the new Health Care for America NOW! coalition - which has not yet backed single-payer health care - held a press conference at Boston City Hall this week. Both formations have involved a fair number of organizations and unions that we have general agreement with on key issues here at Open Media Boston. Ultimately I think MassACT went in the wrong strategic direction in its unwillingness to push for a single-payer state plan. I sincerely hope that HCAN Massachusetts doesn't follow suit this time around.

Far better to use the collective power of such organizational groupings to fight hard for a single-payer health care plan here in the Bay State. And then move on from that victory to help spearhead a successful campaign on the national level.

Will such a strategy be easy? No way. Fast? Not especially. Will there be setbacks? Absolutely. Can it win? Of course. Most other industrialized nations have publicly-funded health care systems - some single-payer, some socialized medicine, some hybrids of various systems - and virtually all of those countries have better health care outcomes for their populations than we do in Massachusetts or the U.S. These systems were not won without major battles by progressive forces against entrenched corporations and political elites. They ultimately prevailed because they made the most sense from a financial and public health perspective.

With the economic situation getting worse every month, and health care already on the chopping block in state government, there is a driving need for advocates to fight harder and smarter for real health care reform.

The possibility for success is certainly there. It's just the will that still seems to be lacking.

So I think it's time for leadership of progressive organizations that work on health care policy to do some real soul searching.

Will you all continue to squirrel around the edges of genuine health care reform - even as the fiscal rug is being pulled out from under your feet? Or will you take some political risks, break out of the supplicant mentality that has pervaded many organizations for decades and take this fight to the mat?

I think it all comes down to whether you all genuinely believe that working families will back you all in this critical area. I, for my part, continue to maintain that working people will back social movements that speak to their core human desire for better material conditions in an inspirational and powerful way. And demonstrate significant political strength when it counts.

Strategies relying primarily on staged public events coupled with backroom political deals brokered from a position of weakness simply aren't going to cut it anymore.

If indeed they ever did.