Implications of the Massachusetts Plan
The Massachusetts plan for universal coverage – recently signed into law – signals a new urgency in addressing the growing crisis in the U.S. health care system and highlights the policy vacuum on this issue in our nation’s capital. I applaud the Massachusetts governor and legislature for their courage and innovation; yet the plan itself is based on a false assumption. Like the Oregon Health Plan – enacted when I was senate president and implemented while I was governor – it treats only a symptom of the problem, not the problem itself.
Certainly ensuring everyone has timely access to needed medical care must be a key objective of any serious reform effort – and expanding coverage was a central component of our efforts in Oregon. But I have come to believe that universal coverage by itself will not solve our health care crisis. For example, everyone over the age of 65 is already covered by the Medicare program, yet the result of this universal coverage is an unfunded entitlement in excess of $65 trillion that casts a dark shadow over our nation’s fiscal future.
The uninsured are the symptom of a much deeper problem. The problem is our federal eligibility and financing structure for health care. This structure reflects the realities of the mid-20th century, not the realities of today, resulting in an increasingly inequitable and unsustainable set of public subsidies. The problem is embedded in the way we define a health care “benefit” and in the payment models and financial incentives through which this health care is delivered.
Achieving universal coverage without examining what is covered and how services are delivered will do little to stem escalating medical costs, make health care more affordable or mitigate the growing disadvantage faced by U.S. businesses competing in a global economy against firms not burdened by the spiraling cost of providing health care to their employees.
Click on the title of the post for the rest of Kitzhaber's essay. He decided recently not to run for governor (a non-consecutive third term), but instead found the Archimedes Movement, which seeks to reform how America deals with health care. Listen to the guy, he's one of the nation's political and medical experts on the subject.