What Me Worry?

As far as I can tell, the gist of this piece on what the Obama administration can learn from Massachusetts’s health-care plans is: don’t worry crafting health-care reform that actually works in any sustainable way — just go with whatever gets everyone to agree and worry about the problems later!

Yet, even now, the lawmakers and strategists behind the Massachusetts plan strongly defend their incremental approach. Only by deferring the big decisions on cost containment, they said in recent interviews, was it possible to build a consensus among doctors, hospitals, insurers, consumers, employers and workers for the requirement that all residents have health insurance.

…The times and the politics are different in Washington, where the recession has convinced both parties that cost containment cannot wait. But by addressing costs and access simultaneously, the White House and Congress risk alienating key interest groups from the get-go.

“When you start talking about cost, you create winners and losers and that leads to a political challenge,” warned Andrew Dreyfus, executive vice president of Blue Cross and Blue Shield of Massachusetts.

…John R. Sasso, a longtime Massachusetts political strategist who represented the state’s largest insurer and largest hospital network in 2006, said that moderation and gradualism had been critical.

“My experience has been that if you start out trying to design the perfect plan you will fail,” he said. “The goal has got to be to deal with all the levers that affect cost and access and quality but to not overreach in any of those areas. Everybody had a certain responsibility but not so onerous, not so tough on the front end, that it would cause people to lose faith in the prospect of covering everybody.”

Isn’t this sort of like arguing that it doesn’t matter if an airplane’s engine works or not, the best way to get it flying is just to roll it off the cliff and deal with whatever come your way? But shh, don’t talk about that faulty engine — we wouldn’t want passengers and crew to “lose faith.” And isn’t it also a tacit acknowledgment that, in order to get the plan passed, backers had to willfully blind themselves to major flaws — flaws that even now mean that the state’s health-care system suffers from massive cost overruns, health-care plans that are far more expensive than expected or advertised, and — crucially for a “universal” plan — fails to even provide true universal coverage? Libertarians hate the plan, naturally, but even given the benefit of the doubt, its success is mixed, and its long-term future is uncertain even those who praise the program worry over its high cost.

The short-term incentives in politics often run towards passage of large-scale legislation without regard to its efficacy, and so, with an any-bill-is-better-than-no-bill ethos in place, we end up with the legislative equivalent of paying shipbuilders to launch the biggest boat they can, all the while accepting their assurances that, even if it’s leaking now, we can always figure out how to float long-term once we’re at sea.