An unprecedented ideological divide over Massachusetts health reform congealed one year ago.
On the political left, a cleavage emerged between those who thought Chapter 58 the worst thing imaginable, a sheep in wolf’s clothing to speed up the demise of employer sponsored coverage and to promote consumer driven policies – an argument advanced by the AFL-CIO (state and national), single payer advocates and others.
Others on the left – the ACT Coalition, Families USA and others – suggested Chapter 58 represented a noteworthy and promising advance, risky and unprecedented, and worth pushing as far as possible.
On the political right, a similar split. One side, represented by the Cato Institute, the Wall Street Journal editorial page, Sally Satel and others attack Chapter 58 as a wolf in sheep’s clothing for single payer, an advance for government controlled health care, and a whole lot worse.
The other part of the right, represented by the Heritage Foundation, Newt Gingrich, and Mitt Romney (until recently), sees a lot to like, finds merit in individual responsibility, and is open to seeing how it can go.
With the notable exception of Romney, everyone’s still in place. Those who hated Chapter 58 one year ago, hate it today. God luv ‘em – they keep the law’s defenders on our feet, challenge us at every step, never let us get complacent. Keep it up, thank you.
And, every group that was part of the coalition supporting the law’s creation is still at the table, compromising, doing the best we can to make implementation work. That says something, and that’s worth something.
As the Connector considers the monumental decision it will make on Thursday defining enforcement parameters for the individual mandate, the policy substance matters, and so do the politics – to enable everyone who wants the law to succeed to continue support.
Recently, Nancy Turnbull created a funky Alexander Calder-type mobile to illustrate health reform, with components of the law as floating colored artifacts. It’s more apt than she realizes. Chapter 58 was the product of a moment in Massachusetts political and health policy history – Bush Administration funding threats compelled action by the Democratic legislature and the Romney Administration. It would not come out the same way today – no way. Just as politics is more art than science, so is Chapter 58.
Lots of folks look at Chapter 58 and say, “ugliest piece of s___ I ever done seen!” Others look and say, “Not too shabby. We could have done worse. Let’s figure out how to use it the best we can, and then figure out next steps.”
That’s where we are today. Happy birthday, Chapter 58.
John McDonough is the Executive Director at Health Care for All
“Those who hated Chapter 58 one year ago, hate it today. God luv ‘em – they keep the law’s defenders on our feet, challenge us at every step, never let us get complacent. Keep it up, thank you.”
John, I don’t believe critics of the law have ever stated that we “hate Chapter 58″ but I am indeed among a very large group of healthcare professonals and others in the state (and across the country) who’ve expressed grave concerns and alarm about particular components of the Chap 58 reform plan.
We worked hard alongside your coalition to support certain pieces of the law and continue to do so. We have also analyzed the details and concluded that the law may well hurt our patiants and our communites in its approach to mandate purchase of private products to be sold at a profit under threat of financial penalty, or involvement of your employer if you seek care through the state’s free care pool.
Speaking up to share these very real concerns and offering alternative reforms has taken a lot of time and effort, so for that I’ll say “You’re welcome”.
Concerns about Chap 58 that must be publicly and honestly discussed include the wasteful decision that this approach uses of building on the private insurance industry that spends only 84% of the dollars they collect on actual healthcare services. 84% figure from data in a recent state-sponsored analysis; read report here http://www.mass.gov/healthcareaccess/)
We all deserve better value for our healthcare dollar, particularly state taxpayers who as we learned yesterday in the new “Chap 58 compromise” will be subsidizing much larger numbers of people to purchase private insurance products under the law’s mandate provision.
There has been very important criticism that Chap 58 does practically nothing to address the already sky-high and rising prices that most of the insured and employers are now being crushed by. Serious cost-controls that are needed to help the growing ranks of the anxiously-insured are all but absent in Chap 58.
In addition to the moral and economic challenge of helping the uninsured, the main element of Chap 58 that has been undertaken in a market-driven mandate appraoch of questionable logic, we have parallel challenges concerning the unmet health and economic needs of the under-insured and the anxiously-insured.
These pressing concerns of the vast majority of voters in the state could have and should have been dealt with much more forthrightly in any state-wide health system reform law, especially when the new Chap 58 law was touted to be a reason for the MA legislature to illegally kill the citizen’s healthcare constitutional amendment that had been 4 years in the making. HC Amendment info at http://www.healthcareformass.org
Much work remains to be done, that’s for sure.