You are using an outdated browser.
Please upgrade your browser
and improve your visit to our site.
Skip Navigation

Massachusetts Miracle--or Catastrophe?

The Institute for America's Future is out with a new report on health care reform in Massachusetts. I've only had time to glance at it, but, upon that immediate inspection, I see that the Institute has found both successes and failures.

The big success is the expansion of insurance coverage; Today, less than 3 percent of state residents have no insurance, less than in any other state. The big failure is the inability to control costs, as a virtual oligopoly of providers and insurers continue to pass along some of the nation's highest medical bills.

Given this reality, the report suggests that reforming health care at the national level must include additional steps, starting with the creation of a public insurance plan into which anybody can enroll. A well-designed public plan would, among other things, help control costs.

I'm still withholding definitive judgment on Massachusetts until I have the time to take a closer look at it. But, based on everything I've heard and read, the Institute's conclusion sounds about right.

But the Institute's framing of the report is another story. Note the headline on the press release:

With exclusive reliance on private insurers and skyrocketing costs, report finds Massachusetts reform is not a good model for the nation

Call it the glass half-empty interpretation, which is becoming a consensus on the left: Massachusetts is a failure. We must avoid repeating its mistakes. 

Me, I'm a glass-half-full kind of guy. My take is that Massachusetts has done some very good things. And while reform at the national level must be more comprehensive, Massachusetts shows that it's possible to make real progress on insurance coverage in a short amount of time.

Note, by the way, that the state is now moving forward on cost control. A new commission is investigating ways of moving the state away from straight fee-for-service and towards payment systems that reward high quality and efficiency. And, as Monday's New York Times article from Kevin Sack noted, many officials and experts in Massachusetts have argued that it is the clear progress on coverage that makes this new discussion possible.

Given the voting strength of fiscal conservatives in Congress, particularly the Senate, it seems to me this is an equally important lesson to draw from Massachusetts: Once you succeed in addressing the coverage problem, it becomes a lot easier to control costs. 

Note: I'll see if somebody affiliated with the Institute wants to post a response here. 

--Jonathan Cohn