The New Health Dialogue

As the world continues to wait for the dust to settle from Massachusetts’ special election, two pieces from last week are worth reading. First, Time’s Karen Tumulty provides an excellent narrative of how the longshot from Wrentham became the Scott heard round the world. Commenting specifically on how Massachusetts could elect a man who pledged to be the 41st vote against health reform to fill the late Edward Kennedy’s seat, Tumulty writes:

As I talked with voters braving the snow to get a glimpse of Brown in the days leading up to the election, the health care issue came up again and again. They were unsettled by the mounting costs of their state's program and even more so by the process they saw going on in Washington. Rather than being drafted with the common good in mind, they said, the health bill was turning into a series of backroom deals -- a Medicaid exemption for Senator Ben Nelson's Nebraska, tax breaks for unions, sweeteners for the hospital and drug industries. As a veteran of the Kennedy political operation put it, "They think there's a lot coming out of Washington -- and none of it is for them."

Second, The Washington Post, in collaboration with the Henry J. Kaiser Family Foundation and Harvard University's School of Public Health, takes a look at the numbers behind Scott Brown's victory in Massachusetts, and particularly the impact of health reform in voters’ decisions. As The Post writes:

Health care topped jobs and the economy as the most important issue driving Massachusetts voters, but among voters for Brown, it was closely followed by the economy and jobs, and "the way Washington is working."

Overall, 43 percent of Massachusetts voters say they support the health-care proposals advanced by Obama and congressional Democrats; 48 percent oppose them. Among Brown's supporters, eight in 10 said they were opposed to the measures, 66 percent of them strongly so.

Sizable majorities of voters for Brown see the Democrats' plan, if passed, as making things worse for their families, the country and Massachusetts. Few Coakley voters see these negatives, and most of those backing her see clear benefits for the country if health-care reform becomes law. Less than half of Coakley's supporters say they or the state would be better off as a result.

Nearly two-thirds of Brown voters believed their state would be worse off if the president and Congress passed health care reform. During the campaign, Brown squared his support of the Massachusetts 2006 health reform legislation (which the Post-Kaiser-Harvard poll shows remained popular even among a majority of Brown voters), by arguing that he opposed “subsidizing what other states have failed to do.”

Brown’s arguments pick up on the underlying issues of state equity in health reform. These issues are inevitable in a health care system where diagnostic tests in Miami can cost as much as three times that of the same treatment in Minneapolis and a state like Massachusetts insures 97 percent of its residents while more than a quarter of the population of Texas goes without coverage. They’ve become more salient in the wake of Sen. Ben Nelson's (D-NE) so-called Cornhusker Kickback, as more and more American’s question what’s in it for them (and their states) on health reform.

The problem is that the process of politics obscures the real impact of policies. The optics of Nelson’s deal was far worse than the practical implications. As for Massachusetts subsidizing what other states have failed to do, the reality is that only federal health reform offers the tools and levers that can slow health care cost growth. Changing Medicare payment policy to promote better, more efficient care, and placing curbs on the growth of high premium plans, are policies that will benefit Bay Staters and reduce the costs of the Massachusetts’ reform.

In a post on Health Affairs’ blog, Claudia Schur and Marc Berk do some back of the envelope calculations to predict the winners and losers from health reform. The irony, they find, is that:

States with the most to gain under health care reform are overwhelmingly represented by Republicans, while those states likely to do worse are much more likely to have Democratic senators.

Democrats need to do a better job of explaining what health reform actually does. When they do, they’ll find a public far more open to their legislative agenda.