A prediction I'm sorry to have to make

Actually I've made it before, but it's now clearer than ever -- in 2009, the Massachusetts attempt to provide universal health insurance coverage to its citizens [sic -- undocumented residents are screwed] is going to blow up like an unarmored humvee hitting a buried artillery shell.

Steffi and David, with colleague Benjamin Day, review the long sad history of failure of state level reform efforts, and they predict that Massachusetts is going to hit the wall because a) the so-called "affordable plan" that people with too much income to qualify for the subsidy have to buy is already unaffordable, and b) Massachusetts is going to lose the federal subsidy next year. Let me add to that:

1) The private insurance companies that provide the "affordable" plans underbid and they are losing money. They're going to come back with an even higher price next year;
2) The recession means lower state tax revenues even as --
3) Employers are covering fewer and fewer of their workers and people are losing jobs or being downgraded to part time and lower pay
4) The state already faces a huge budget deficit and
5) The cost of health care continues its inexorable rise.

Bottom line: the numbers don't add up -- they never did -- the money isn't there, the mandate will be repealed, and we will have more, not fewer people uninsured one year from now than we do today.

The reason this doesn't work is because it isn't true reform. It takes the existing system of fragmented, largely private health care insurance as a given and tries one way or another to stretch it to cover more people. But it does nothing to bring down costs, doesn't have sufficiently progressive financing, and doesn't get rid of the waste. States cannot fundamentally reform the system because health care is part of a national market and a national system. Pharmaceuticals, devices, labor, capital are all traded and regulated nationally. Massachusetts can't force insurers or drug companies or doctors or anybody else to accept its terms. And the politicians are much too timid and much too bought to undertake, or even talk about real reform anyway, because it means getting rid of the insurance companies entirely, which we cannot do even though they provide no socially useful function whatsoever; and it means limiting the profits of drug companies and the incomes of highly paid medical specialists. (Primary care docs should be making more than they are now, and there should be more of them, by the way. Doctors can be winners with real reform, but not all of them.)

The smash up of the Massachusetts experiment may finally convince the wimps in the reform movement that we need to stop farting around with half-assed measures and go for the real thing; or it may set us back 20 years. I don't know. But I do know this:

We need universal, comprehensive, single payer national health care.

Say it again!