Don't wait up for me . . .

I will probably be away from Your Internets for a couple of days while I do some construction work and study up for my Jeopardy! audition (seriously -- I'm going to be memorizing all the presidents, state capitals, and Foods that Begin with the Letter Q).

Meanwhile, my friends have asked me to be constructive and positive about the new Massachusetts health care legislation. Okay. The deal is, what happens from here, over the next couple of years, is what really matters. This is the beginning, and we're starting on the top of a very steep ridge. We could fall off to either side. It's because he hopes we'll fall to the wrong side that the Republican governor and candidate for president supported the bill. It's because they hope we'll fall off to the right side (which I suppose would be the left side) that Health Care for All, unions and other progressive organizations supported it.

The wrong side is that there isn't enough money to make the subsidized plan for low income people really affordable, and the "affordable" plan for moderate income people is crappy insurance that still isn't affordable; while employers continue to bail out of providing decent insurance because they can dump people onto the subsidized and "affordable" plans for only $295 a year. Most people end up with high-deductible insurance that they are forced to buy, that doesn't cover their routine and preventive care, for which they now pay out of pocket. Poor people are forced to buy insurance they can't afford, and the political pressure forces the legislature to make that insurance worse and worse -- less comprehensive, with higher cost sharing. Massachusetts enters the Cato Foundation utopia.

The right side is that the subsidized plan really is affordable and comprehensive. Because a much higher percentage of the population is in the public insurance pool, the state gets a real handle on health care costs, by gaining the leverage it needs over hospitals while promoting good quality care and giving people at risk the prevention and early intervention services that will really save money in the long run. At some point, the legislature raises the $295 assessment on employers that don't provide insurance and turns it into a payroll tax with an exemption for the first $10,000 or so in pay per employee, so that it is both progressive (instead of the regressive job tax we have now) and provides enough incentive that employers won't stop providing insurance. Eligibility for the public plan is extended, so that moderate income people can buy in at full price instead of buying the crappy "affordable plan," and the public plan is affordable for them because it has buying power and can effectively control costs while maintaining quality care. We start to move toward where we really want to go.

Can that work in a single state? Therein lies a real and possibily insurmountable problem. More on that later.