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The NY Times Horks Up Another Healthcare Hairball

The New York Times editorial board this morning has, in classic NYT fashion, sprung to the vigorous but qualified defense of the Massachusetts health financing system.

Massachusetts’s experiment in near universal health care coverage has become a favorite whipping boy for opponents of health care reform. They claim the program is a fiscal disaster and that the whole country will be plunged into a similar disaster if President Obama and Congress’s Democratic leaders have their way.

That is an egregious misreading of what is happening in Massachusetts. The state’s experience so far suggests that it is more than possible to insure almost all citizens and stay within planned budgets — although it will take great creativity and political will to hold down rising costs so that the program is sustainable.

Just as a matter of instinct, given what we know about the consequences of "financial innovation," the invocation of "creativity" should activate a fight-or-flight response.

The editorial provides a succinct description of the Mass system, which of course is basically Obamacare without the public option:

Massachusetts requires everyone to take out health insurance or pay a tax penalty (unless they are deemed unable to afford coverage). It requires employers to offer coverage or pay a modest fee. It has expanded Medicaid to cover more of the poor and provides subsidies to help other low- and moderate-income residents buy insurance. And it has established an exchange where people not covered at work can choose from policies offered by private insurers who compete for their business.

As it proceeds to describe the Massachusetts system, with which others here (hello selise?) have direct familiarity, the editorial seems to demonstrate that if not "disastrous," the system is, at minimum, ailing:

The initially generous insurance benefits had to be scaled back to keep costs manageable. Cigarette taxes had to be raised to help pay for the reform. The number of people reporting problems paying medical bills and gaining access to care, after falling sharply, has begun to rise again. Tens of thousands of people who make too much to qualify for subsidies have to be exempted from the mandate each year on the grounds that they cannot afford to buy insurance. People just above the exemption level who lack employer coverage often face what they consider very high premiums.

For anyone who believes that the addition of a public option, especially one as paltry as that offered in HR 3200, to a nationally scaled-up Mass plan would fix its systemic deficiencies, I have a Boston Harbor tunnel I’d like to sell you.

But that’s not really where I’m going in this post. Instead, I want to point out two interlocking points that writers on the agenda-setting function of the media (eg, Parenti, Chomsky/Herman) have identified:

1. The true power of the mass media resides in their ability not to persuade but ignore;

2. The mass media have only limited ability to control what people think, but they have great power to direct what people think about.

In the present case, a key ignored fact is that we’re talking about insurance, not health care, and private insurance (as PNHP continually reminds us) is a defective product. It remains so under Masscare and would remain so under Obamacare, despite cheery assurances by its proponents about people’s access to "good" insurance. Not to be too brutal about it, but Nataline Sarkisyan had "good," unrescinded insurance. So did Donna Smith, when she and her husband were driven into bankruptcy and compelled to move in with their adult children.

Consider the sanitized flat affect of the line from above: "The initially generous insurance benefits had to be scaled back to keep costs manageable." What proportion of those scaled-back benefits were nonetheless medically necessary? And who shouldered the costs?

Which brings us to the power of the media to direct what we think about. The issue, as the editorial frames it, is whether and to what degree the Mass plan is a fiscal disaster. But what matters to people is the degree to which it is a human disaster.

Private health insurance is a defective product regardless of whether barriers to qualifying for it are lifted or the cost of purchasing it is partially subsidized. It is defective because it diverts dollars directed at the alleviation of suffering to corporate profits. That will not change with the tweaking of the Mass plan to insure more people, or with its scaling up to a national scale, or even with competitive pressure from a public plan, which will only spur corporate creativity (Run Away!!) on how to maximally squeeze profits out of reduced premiums.

Obamacare may be the best we’re going to get for now, and there are strong arguments for getting it rather than sticking with the status quo. But it will preserve the worst systemic flaws of the status quo, and no amount of deflected attention toward the "fiscal" and away from the "human" will change that.

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