Yeah, but Massachusetts isnt' the only state where health insurance premiums are increasing rapidly. 11 states will see
double digit insurance rate increases for 2010. Nationally they will be more than double next year over 2000, so to argue that the status quo is working is becoming increasingly untenable.
No one is saying that the Massachusetts reform solved all problems, or that it was going to solve the biggest problem, which is the rate of increase in costs, which are driven by the cost of technology as well as incentives built into the system. The whole argument about the "cost to the taxpayers" really misses the point, because successful reform should be a net benefit to society, period. Obviously it would be great if it were a benefit to government finances, but the more important thing is that there is a more sustainable health care system with better cost incentives. Over the long run that is also what will benefit government finances.
The two main problems are that providers are paid more for giving more services, and patients see no cost for using more services. If patients were forced to pay more for a more expensive treatment, then they would themselves more carefully consider whether they wanted to use that treatment. And providers would perhaps not recommend so many more extra treatments if they bore some of the cost themselves rather than just passing it off. Incentivization is at the heart of ER utilizations, premiums rises, and doctors' acceptances.
To some extent, the increased number of people covered, while very important, is a sideshow to the systemic cost issue. The main benefit would be through a mandate that would lower insurance costs overall. It is also fair prima facie, because since everyone has access to ER, everyone should share some of the costs. However it is not the crux of the cost problem.
None of this touches on what the
real problem is, however-- which is political paralysis. The reason why no one has touched costs is not that no one has any good ideas to control costs-- it's that doing so would be politically too difficult-- too many special interests involved. Even Obama's miniscule attempt failed. This is a political problem with our system of government, not a policy problem.
Since the GOP and the conservative movement tends to be much more cohesive, fanatical, and in control of the media than the Democrats, I think the best hope for real health care reform right now, ironically, is a big Republican win 2012. Unlike the past, the GOP will be forced to recognize that the status quo is untenable, and hopefully the GOP will be convinced that big reform is needed. With their conservative legions standing behind a popular GOP President, I think many conservatives would support things that they claim to oppose to the death under Obama. With their lockstep thinking, massive propaganda outlets, and especially if their reform throws some bones to liberals (like expanded coverage), a health care reform push by the GOP might very well be the best chance at reform. The key difference between them and Democrats is spine.
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