By Froma Harrop
The miracle in Massachusetts was made possible through a bigger miracle four years ago. That’s when the commonwealth became the first and so far only state to guarantee near-universal coverage. The Republican winner of the Senate seat long held by Ted Kennedy, Scott Brown, voted for the legislation as a state senator. In vowing to be the key 41st vote against the Democrats’ health care reforms, Brown carefully added that Massachusetts voters should not worry about their own health care security: They already have it through the state program.
Thus, Massachusetts was the worst state in which to test the wider public’s feelings about national health care reform. Polls showed people in Massachusetts, as elsewhere, unhappy with the legislation in Washington. But those numbers include many who thought the reforms too weak or were simply disgusted by the legislative sausage-making. And whether these proposals were better than nothing is a meaningless question to people who already have something.
The foes of health reform have long used a divide-and-conquer strategy in crafting an anti-reform coalition. They pit those who have government-guaranteed health care, such as the elderly, against those who don’t. Rest assured that if there were no Medicare, the older folk with tea bags stapled to their hats would be on the other side of the barricades. Medicare is the most socialized element of the American health care system.
Similarly, the damp enthusiasm in Massachusetts for the reforms coming out of Washington belies the popularity of the state reforms enacted in 2006. “It’s not perfect,” a Brown supporter told a reporter, “but why should we have to pay again when we have health care?”
Not perfect is an understatement. Unlike the legislation in Congress, the Massachusetts plan made virtually no effort to contain spiraling health care costs. That makes the Massachusetts health care plan, which Brown still supports, far less conservative than the national version he opposes.
But despite the program’s unexpected costs — despite its individual mandate to obtain coverage or face a fine — the Massachusetts program retains solid backing at home. Once people realize that whatever happens to their job, whatever dire disease befalls a family member, they can get medical care without having to sell their house, they won’t let anyone take it away.
So there’s no talk of repealing the Massachusetts program, but of bringing it back to the lab for repair. The state has already cut benefits and raised taxes. A special commission is now urging a move away from expensive fee-for-service health care and to a model that would pay groups of doctors and hospitals fixed sums to cover the patient for a year.
Politically, the Massachusetts program could serve as a national model. Pass universal coverage now, fix it later.
Even though their reforms are superior, Democrats in Washington could have done better still by not trying to please everyone (including Republicans who were just playing with them). But despite their control of the White House and majorities in Congress, Democrats seemed capable only of reacting to critics, of cringing with fear under even the most ludicrous attacks.
If you don’t have the courage of your convictions, it doesn’t matter whether your party has 59 or 60 or 65 seats in the Senate. Under President Bush, Republicans got whatever they wanted with 50 senators.
The Democrats remind me of King Lear. Having given away his land, the source of kingly power, Lear turns to his fool for amusement and threatens to whip him. “I am better than thou art now,” responds the cheeky fool, who like all Shakespeare fools, has everything figured out. “I am a fool; thou art nothing.”
Froma Harrop is a Providence Journal columnist. Her e-mail address is firstname.lastname@example.org.