What is Health Care Success?

Ezra Klein has a great blog on the Massachusetts health care reform plan, where he establishes that Massachusetts is only a health care "success" if it shortens the length between the goal posts, making up its own definition of success, even if it's not actually successful. Of course, Ezra isn't as damning as I am, because the Massachusetts plan does do some good things, but as Ezra notes the reform is more of a small effort than revolutionary. Why? Massachusetts, in fact, only attempts to solve one health care problem - access - while ignoring the other two: quality and cost.

However, that's not the only problem afoot; there's a far more nefarious one, sneaking up on us as each year goes by. By tackling access first, is the Bay State really setting itself up for failure? Access, sadly, is costing the state far more than it originally thought, so without addressing affordability soon, Massachusetts may just be pricing itself out of its reform:

The mandate presumes residents can afford coverage, and it'll spark a political revolt if voters find themselves penalized for not buying a product they can't afford. In other words, one of two things can happen: Either Massachusetts can figure out how to control costs, or it can let the program become unaffordable and repeal the legislation....

Expanding access creates pressures that force the system to figure out how to control costs.

Complicating matters is the fact that the Massachusetts plan has become very popular. Of course, Ezra sees this as a good sign - the Massachusetts plan has been doing a good job in terms of increasing access. It may not be a revolutionary plan, but people like the fact that we're now a near-universally covered state. Ezra knows that we're pricing ourselves out of health care reform, but he fails to see how a popular but unsustainable plan is not necessarily a good thing. As far as politicians and most constituents are concerned, it's mission accomplished - until the shit hits the fan and it's too late to do anything about it.

And what would happen if that's the case? A Mass failure will have ramifications far and wide. Will it be Hillarycare 2.0 - sapping our will to do anything about health care for decades? Worse yet, will the state keep a mandate long after its expiration date - when health care becomes increasingly bad and less affordable every year, to the extent that it's both worthless and expensive at the same time? These are all horror scenarios, but are they in any way unlikely? And what will happen across the nation if the Massachusetts plan fails, since our plan is to health care what Luke Skywalker is to the Jedi Order.

Then again, maybe the mandate will be enough. Maybe politicians will find our health care reform so important that they'll be inspired to address the growing cost problem by finishing the health care reform job. However, that will mean butting heads with HMOs and the Walmarts of the state - and there's not a lengthy history here that should make people confident that our government is capable of doing that. Heck, the health care reform bill was only possible because it's essentially a free government giveaway to HMO Blue. No one wanted this reform more than the HMOs.

If the mandate provides enough incentive to deal with rising costs before those costs shoot right through our glass ceilings, then Massachusetts will have been a complete success - locally. Even so, that's not to say what was done here can, in any way, be duplicated. No matter what, dealing with access before a state reels in costs, without sacrificing quality, is too much pressure for most anything to handle. If anything, Ezra needs to expand on his point and come right out and say it: this country has health care reform backwards. It needs to deal with costs and quality first, then access almost takes care of itself.