Three years ago the Commonwealth of Massachusetts enacted a far-reaching health reform law that politicians and the media hailed as a model for other states and the federal government. Indeed that law has become the major blueprint for health system change on a national scale, and its advocates are aggressively marketing some variation of the Massachusetts plan as the reform of choice. Until recently, there has been little analysis of how the law has worked. Today we begin a series of posts that will explore the Massachusetts law with an eye toward helping the press and the public understand the flashpoints as legislation based on the Bay State’s experiment winds its way through Congress. The entire series is archived here.
In mid-February, the consumer advocacy group Public Citizen held a press conference alerting the media to the shortcomings of Massachusetts health reform. Familiar supporters of national health insurance—or a “single-payer system,” as it’s now euphemistically called—acknowledged that the law had had some success, but also pointed out several problems that up to that point had not been widely discussed. Dr. Rachel Nardin, who heads the Massachusetts chapter of Physicians for a National Health Program, noted that having health insurance was not the same as getting health care. Thirteen percent of people in the state who had insurance still could not pay for some health services, and 13 percent could not pay for their medicines, she said. Dr. Steffie Woolhandler, a professor at the Harvard Medical School, explained how the law encouraged the overuse of costly high-tech care while damaging the finances of safety-net hospitals.
The report—and an open letter to Senator Edward Kennedy, signed by 500 of the state’s doctors and urging Kennedy to push for a single-payer plan instead of a Massachusetts knock-off—got some press pick-up; but not as much as Public Citizen’s PR folks had hoped. The Boston Globe ran a short piece, and CBS gave it a mention. It was mostly specialized and trade pubs, though, like The Hill, Investor’s Business Daily, Health Plan Insider, and McKnight’s Long Term Care News, that carried the story.
Last week the Institute for America’s Future, a leftish advocacy group, released a similar report documenting what it considered failings in Massachusetts. Its key conclusion: “Since the Massachusetts plan does not contain any mechanisms for reining in the rapidly increasing cost of health care, the plan has limited potential for long-term sustainability.” Press coverage was still scant. Jonathan Cohn picked it up for his blog, Philip Klein posted on the American Spectator blog, and the Boston Herald ran a brief piece.
But the messengers of negative news, nevertheless, tried to put a positive spin on their poor-to-mediocre press showing. Angela Bradbery, Public Citizen’s communications director, said her staff had tried hard to generate interest at all the major news outlets, and that she was pleased that 250 journalists opened the press release. “We think it will greatly improve the coverage of this issue as the health debate unfolds.” And even good reporters are just “getting up to speed on health care choices,” said Diane Archer, a researcher at the Institute. She believes her group will have a long-term impact even if its report didn’t get next-day, nation-wide coverage.
The lack of media coverage that honestly looks at the successes and the failures of the Massachusetts plan, however, stands in stark contrast to the near-universal press enthusiasm that greeted the passage of the law in April 2006. Photos of Senator Kennedy, then-Governor Mitt Romney, and representatives of the state’s medical establishment and consumer organizations congratulating themselves—and headlines like “A Health Fix That Is Not A Fantasy” in The New York Times—seemed to say it all. Romney himself got a lot of ink when he proclaimed that “Massachusetts is leading the way with health insurance for everyone, without a government takeover and without raising taxes.”
The law essentially left in place the existing health insurance structure and rearranged money within the system. It required no serious cost-containment measures that would have assured the program’s future, but would have cut into the profits of the state’s powerful medical and insurance interests. Employers still cover their workers, insurance companies still sell policies that pay for care at the state’s high-end hospitals, and a federal infusion of cash allows the state to expand Medicaid coverage.