Because of President Obama's frantic approach, health care has run off the rails. For the sake of 47 million uninsured Americans, we need to get it back on track.
(Now insured: Francisco Diaz of Boston consults with nurse practitioner Anna Hackett Peterson./Josh T. Reynolds for USA TODAY; Mitt Romney./AP)
Health care cannot be handled the same way as the stimulus and cap-and-trade bills. With those, the president stuck to the old style of lawmaking: He threw in every special favor imaginable, ground it up and crammed it through a partisan Democratic Congress. Health care is simply too important to the economy, to employment and to America's families to be larded up and rushed through on an artificial deadline. There's a better way. And the lessons we learned in Massachusetts could help Washington find it.
No other state has made as much progress in covering their uninsured as Massachusetts. The bill that made it happen wasn't a rush job. Shortly after becoming governor, I worked in a bipartisan fashion with Democrats to insure all our citizens. It took almost two years to find a solution. When we did, it passed the 200-member legislature with only two dissenting votes. It had the support of the business community, the hospital sector and insurers. For health care reform to succeed in Washington, the president must finally do what he promised during the campaign: Work with Republicans as well as Democrats.
Massachusetts also proved that you don't need government insurance. Our citizens purchase private, free-market medical insurance. There is no "public option." With more than 1,300 health insurance companies, a federal government insurance company isn't necessary. It would inevitably lead to massive taxpayer subsidies, to lobbyist-inspired coverage mandates and to the liberals' dream: a European-style single-payer system. To find common ground with skeptical Republicans and conservative Democrats, the president will have to jettison left-wing ideology for practicality and dump the public option.
The cost issue
Our experience also demonstrates that getting every citizen insured doesn't have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages "free riders" to take responsibility for themselves rather than pass their medical costs on to others. This doesn't cost the government a single dollar. Second, we helped pay for our new program by ending an old one " something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.
When our bill passed three years ago, the legislature projected that our program would cost $725 million in 2009. At $723 million, next year's forecast is pretty much on target. When you calculate all the savings, including that from the free hospital care we eliminated, the net cost to the state is approximately $350 million. The watchdog Massachusetts Taxpayers Foundation concluded that our program's cost is "relatively modest" and "well within initial projections."
And if subsidies and coverages are reined in, as I've suggested, the Massachusetts program could actually break even. One thing is certain: The president must insist on a program that doesn't add to our spending burden. We simply cannot afford another trillion-dollar mistake.
The Massachusetts reform aimed at getting virtually all our citizens insured. In that, it worked: 98% of our citizens are insured, 440,000 previously uninsured are covered and almost half of those purchased insurance on their own, with no subsidy. But overall, health care inflation has continued its relentless rise. Here is where the federal government can do something we could not: Take steps to stop or slow medical inflation.
At the core of our health cost problem is an incentive problem. Patients don't care what treatments cost once they pass the deductible. And providers are paid more when they do more; they are paid for quantity, not quality. We will tame runaway costs only when we change incentives. We might do what some countries have done: Require patients to pay a portion of their bill, except for certain conditions. And providers could be paid an annual fixed fee for the primary care of an individual and a separate fixed fee for the treatment of a specific condition. These approaches have far more promise than the usual bromides of electronic medical records, transparency and pay-for-performance, helpful though they will be.
Why is this model not being discussed as a possible option?