By Aaron E. Carroll
Associate Professor of Pediatrics, Indiana University School of Medicine
The Huffington Post
October 26, 2009
We’re so close to health care reform! Even Paul Krugman is starting to talk about what comes next. Me? I’ve been thinking about what comes next for a long time. I think this bill will pass. We will get the incremental reforms we were promised. Things will likely get better in the short term. Then, since we didn’t contain costs, we’ll need to enact real reform. Or, things will go right back to the status quo.
How do I know that? We’ve been here before.
President Obama said, in his address to Congress, that he was determined to be the last president to deal with health care reform. That’s not going to happen. He should have read his history. At least, he should have read the New York Times.
Governor Romney thought the same thing in Massachusetts in 2006. I saw it â€“ right there in the New York Times:
The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.
“This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone.”
But wait. I’d heard that before. In the New York Times. In 1988:
Massachusetts last week ventured where no state had gone before: It guaranteed health insurance for every resident.
The plan requires that by 1992 every employer of six or more pay $1,680 per worker per year for insurance. The employer may buy the insurance directly for his workers and their dependents, thereby earning a tax credit…The Massachusetts plan recognizes the value of an employer-based approach, which it would expand by forcing more businesses either to insure or pay.
That time was under Governor Dukakis. He was going to be the last one to deal with health care reform, too. Just so you know, the rate of uninsurance in Massachusetts was 8.4% in 1998 around the time of the first “unique” reform and 5.5% in 2008, after two times they said they were going to achieve universal coverage. I don’t think they understood the concept of “fixed”.
And that’s just Massachusetts. Look at Tennessee. They went all out with incremental reform in 1994. There’s that New York Times again:
The Tennessee program, which went into effect last Jan. 1, covers 803,800 people who were formerly on Medicaid and 335,300 who had no health insurance. Gov. Ned McWherter, a Democrat, said that 94 percent of the state’s residents were now insured. He predicted, “Tennessee will cover at least 95 percent of its citizens with health insurance by the end of 1994, seven years faster than the most aggressive goal set for the nation under legislation being debated in Congress.”
Tennessee’s rate of uninsurance was 10.2% in 1994 and 15.1% in 2008.
Governor Dean, no stranger to the cause of health care reform, “fixed” the problem of health care reform way back in 1992. Per the New York Times:
Gov. Howard Dean, the only Governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal health care by 1995.
The Vermont law creates a state agency, the Health Care Authority, that will have the power to bargain for health insurance for the state’s residents, using what Governor Dean called “enormous leverage” to gain better coverage at lower rates.
Wow. That sounds like… a public option! Let’s go to the scoreboard: Vermont’s rate of uninsurance was 9.5% in 1992 and 9.3% in 2008.
Minnesota tried this, too, in 1992. Of course, how would anyone know about that? It was only in the New York Times:
Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it.
The legislation, called HealthRight, provides state-subsidized insurance coverage for people of modest income, a provision that is expected to cost Minnesota $250 million a year, along with steps to control the health-care industry’s steeply rising charges.
Subsidies to buy insurance. That must have worked, right? Minnesota’s rate of uninsurance was 8.1% in 1992 and 8.7% in 2008.
Washington State? 1993. New York Times:
Washington will have one of the most aggressive health-care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state and try to control costs through a cap on insurance premiums.
The plan would require all employers to pay at least half the cost of health insurance premiums for their employees… “We weren’t going to create some huge new government bureaucracy, so we took that away from the critics.”
God forbid! A government system might actually… I don’t know… do something. Anyway, Washington’s rate of uninsurance was 12.6% in 1993 and 12.4% in 2008.
Since the administration has put Senator Snowe somewhat in charge of health care reform, you would think they would at least know about efforts in Maine. Right? To the New York Times, please!
The Maine Legislature today passed a comprehensive health insurance plan that will make low-cost coverage available to all state residents by 2009.
The legislation will create a semiprivate agency that provides private coverage to the state’s 180,000 uninsured residents, businesses and municipalities with fewer than 50 employees and the self-employed. Employers would pay up to 60 percent of an employee’s premium.
That looks like it could have come right out of HR 3200. You’d never know if was from 2003. How did that pledge to achieve universal coverage by 2009 go? Maine’s rate of uninsurance was 10.4% in 2003 and 10.4% in 2008.
We pretend these problems are new; we pretend that these solutions are new. Subsidies have been done. Community ratings are old news. “Public plans” have been around for a while. Mandates, both individual and employer, weren’t invented this year.
In 1988, before the first of these plans went into effect, 13.4% of Americans were uninsured. In 2008, it was 15.4% of Americans. They don’t work. Not in the long run.
We need comprehensive reform. This plan will pass; it won’t be enough. President Obama will not be the last President to deal with this problem.
We keep doing the same thing and expecting a different outcome. What does that signify?
Read more about health care policy and get your questions answered at Rational Arguments.
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