Wonk On!

Readers are begging for more about the Massachusetts health care reform legislation. Okay, not begging, but they have expressed mild interest. You can get a one page overview here, and the authority responsible for administering the law, called (weirdly) The Connector, provides links to the actual legislation and associated regulations here.

Unfortunately, in my view, this legislation has become the model for the leading Democratic national proposals. To answer Kathy A.'s question, the law provides sliding scale subsidies for low and moderate income people to purchase insurance. To answer Roger's question, it provides for fairly stiff fines for individuals who don't get insurance, although less than the cost of actually buying it.

For low income people, it's definitely a good deal -- they pay little or nothing and get pretty good, comprehensive insurance. For middle income people whose employers don't provide insurance, it's more problematic. Insurers are required to offer a so-called "affordable plan" for those people, but the plans are either not very affordable or pretty crappy, with high deductibles and co-pays. Also, the premiums are age rated. This puts people in their 50s and early 60s in a tough spot.

I wish it were possible to talk about health insurance without being long winded and boring. I've been trying my entire career to find a way to do it, and I just can't. So here goes. In addition to squeezing some of our citizens, the law squeezes the hell out of the state, which is going to have a hard time coming up with the financing to make it work. As the cost of health care keeps going up, it's just going to get harder and harder.

And there's the rub (whatever that means). The legislation does nothing to control costs. The forces which relentlessly drive up the cost of health care are untouched. There are two essential issues in health care, and unfortunately, progressive politicians only focus on one of them. The first is the people without health care insurance. Hillary and Obama (and she prefers to be called by her first name and he by his last, based on their campaign signs, so I'm not being sexist) want to do something about that problem. But they won't take on the second issue, which is the grossly disprortionate share of society's resources that go to health care. Obama gives lip service to that, but he doesn't offer any real solution.

The real solution is that we need a way to say no. We need to provide the services to everyone that really are worth the money, that really will improve their quality of life and worthwhile years of longevity -- and some years of longevity are not worthwhile, as we all know. And we need to not spend money on drugs and procedures that just aren't worth it. The only way to achieve that is to set a budget. Figure out how much is worth spending on health care, and allocate it in the most effective way. The word for that is rationing, and people don't want to hear it. But it's the only way to solve this problem. There is such a thing as enough, and there is such a thing as too much.