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November 05, 2005

Pols show their true colors on health care

The health care issue is so big, and the stakes are so high, that it's the kind of issue on which politicians get to show what they're really made of, for better or worse.

So far, it's mostly been for the better.  Sal DiMasi, whose penchant for golfing during business hours had become something of a concern, showed that when he sets his mind to it, he really does have the "vision thing."  DiMasi gave an extraordinary speech during the first gay marriage debate a couple of years ago - he spoke movingly of his father, and of the old-timers in his North End neighborhood, and of why they might not agree with him, but why he nonetheless had concluded that the values that they instilled in him led him to his strong support of same-sex marriage.  Agree or disagree with his bottom line, it was a great moment.  That's the DiMasi who had been MIA for a while, but who reappeared this week in health care.  Glad to see ya, Sal - we missed you.

Senate President Travaglini's instinct for caution, deliberation, and reaching consensus before acting is praiseworthy, but this week it ran the risk of making him look timid.  Yet today we read that he has agreed to move the health care debate forward, promising a Senate debate before Thanksgiving.  Good.  There's no question that Trav's heart is in the right place on this issue - the question was (and, to some extent in my mind, still is) whether he is willing to move with the impressive boldness shown by the House - in the process pissing off the Governor and powerful business interests.  His intention to act sooner rather than later is, I think, an encouraging sign.  Go to it, Trav.

The gubernatorial candidates are also weighing in.  Deval Patrick has announced his full support for the House approach, describing the House's action as "a huge opportunity."  Bold and progressive.  Bill Galvin (who still hasn't announced whether he's running) is less happy, concerned that the bill is actually a giveaway to the HMOs, though he hasn't really said why, or what his alternative is.  Confusing.  And Tom Reilly says ... uh ... Tom?  Hello?

Posted by David at 09:57 AM in Health Care, Massachusetts | Permalink


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Wow. Hard to believe this actually has a shot.

I really like Mr. Patrick's attitude. I think having a "we can do this" position, understanding that it might change in the deails but the goal is the same, is really important around heath care.

A little dissapointed in Mr. Galvin. That's naysayer stuff, weakens the goal and confuses the end goal. I understand he wants to focus on everyone's cost, but we'll get to that...

Mr. Reilly....who is that? No seriously, does Mr. Reilly have a poistion on anything? That's really scary when you want to be governor and you can't discuss a major issue like this.

Posted by: Julie Vickery | Nov 5, 2005 11:43:48 AM

It seems like there are always reasons for politicians to be against fixing health care, and it is so nice to see DiMasi take a bold stand on this. And kudos to Patrick for his support. Health Care is going to require some revolutionary thinking to get this fixed.

I love how the House took some of the ideas put forward by Romney, then took those ideas to another level to really challenge this state to rebuild the system, rather than putting a band-aid on the old system. They left just enough of Romney's ideas in place that it will be hard for him to veto what may seem like his own bill. And yet, they put in enough new measures that really will challenge Massachusetts businesses to take responsibility for putting too much of the burden on the state and on individuals. Romney will have a hard time approving those measures. It's a tough position for him, and I have to admit, I like the idea of him squirming a bit on this.

And once again, while Massachusetts is talking about major issues facing the state, Reilly is nowhere to be found. It was almost a miracle to see Reilly coming out of his shell for a rare moment talking about immigrants this week. It would be nice if he would be willing to let us know what he believes, given that he hopes to have our votes for governor.

I have to admit that I do have some concerns about the penalties on individuals who can't afford healthcare.

But overall, this seems like a very strong start to this bill, I'm glad Deval is onboard, at least Galvin is willing to say what he thinks, and Reilly and Romney are bound to show up at some point, one hopes.

Posted by: Qane | Nov 5, 2005 1:13:36 PM

I've read stuff which suggests that you can't really control cost until you make a commitment to universal coverage, because otherwise it's too easy to price people out of the system.

Posted by: Abby | Nov 5, 2005 2:09:05 PM

Deval Patrick had asserted on many public occasions that he saw the 'end game' as a truly universal and equal single-payer system. Then he decided that that was a little too hot politically. So, bold and progressive is not really how I would characterize Patrick's falling into line behind DiMasi et al.
You know, there was once a time not too many moons ago when civil unions were considered a radical propostion made only by true progressives. Now it is considered the fallback position for politicians who might be too timid to take a truly bold and progressive stance. It looks like that is what's happening now with Mr. Patrick.

Posted by: fair deal | Nov 5, 2005 3:24:14 PM

Fair deal, you are almost correct. Patrick did say that he saw the end game of eventually getting to single-payer. However he has always maintained that he didn't believe that was the initial direction that health care reform should go. He has even said that he wasn't sure that single-payer was something the state would achieve in his administration, were he to become governor, but that he hoped to take steps to point the state in that direction.

If you look at his webpage and download his health care plan, announced about a month ago, you'll see that this resides directly in line with the goals he set out for his administration.

But even while it's easy to take pot shots based on false information, I'm not exactly sure why you would criticize a man for supporting a good bill. Do you think the mark of a good politician is to oppose someone else's plan simply because he didn't come up with it? Or is the mark of a good political leader a man who recognizes a quality bill, sees that it achieves many of the goals he wants to achieve, and will stand in support of it, even if that might mean he won't get any credit for it's implementation?

Isn't that the kind of political leader we want? Isn't that what policital courage should be?

Posted by: Qane | Nov 5, 2005 4:15:34 PM

^ What Q said. To add to the point, I don't think it's fair to compare the civil unions/marriage debate to health care. Patrick has always been clear that he sees true universal coverage as the goal, and a plan like this one as a substantial improvement over the status quo that might actually be politically feasible. No one expects that if this bill passes, Patrick will suddenly stop pushing for universal coverage. In contrast, the "compromise amendment" was a way of saying "civil unions, but no more." Reasonable people can disagree on the best way to attain a goal. If you, fair deal, think that Patrick is wrong to accept an interim step - "the whole enchilada or nothing" - that's your view, but to my mind it doesn't make Patrick less progressive. It just makes him pragmatic - a useful trait in a politician.

Posted by: David | Nov 5, 2005 5:44:57 PM

Qane, I'm not really sure that this was a pot shot based on false information. On Patrick's website, he identifies his criteria for healthcare reform as accessibility, affordability, portability, being safe (?), patient-centered and effective. While the House bill certainly expands accessibilty, it's affordability and portability is not all that clear to me. Perhaps you can help explain this to us. And as far as safety, patient-centeredness, and effectiveness are concerned, I just haven't seen how the Bill does anything in particular to improve on the current situation.
I appreciate Mr. Patrick entering into the debate and I wish him the best of luck, but I just don't think that he has done anything out-of-the-box enough yet to earn the title of Bold Leader on this issue.
The point is that the House bill is about a 180 against the concept of single payer. Whereas advocates of single payer want to join the rest of the industrialized world and eliminate employer based healthcare delivery, the current proposal would enshrine this fundamentally flawed system into law. So how this is a step towards the goal of true universal equitable care, well I just don't see the logic. So, it sure looks like an about-face from Patrick.
Please explain this for dolts like I.

Posted by: fair deal | Nov 5, 2005 5:46:45 PM

There's a bit of a semantic game going on here. If the goal is "everyone has health insurance," then there's really no disputing that the House bill is a big step in that direction, and I take it that is what Patrick is after. On the other hand, if the goal is "single-payer health care," you have a point - but reading through Patrick's health care plan, I don't see a reference to single payer.

Posted by: David | Nov 5, 2005 5:55:24 PM

Sorry, fair deal, I think you are off base. As David points out, the first goal here is to get more people covered. The affordability is a part of that.

A big reason health care costs are so high is because hospitals take a huge hit with uninsured patients, and pass that hit on to the bills of the insured. If the bills of insured patients go down because there aren't many uninsured patients left (presumably), that brings all costs down. People either have the get their insurance covered by their employer, buy into health care, or sign up for free care. They won't be able to show up in hospitals and have the rest of us pay their bill the way we do now.

I would hope that another part of this bill is demanding lower-cost catastrophic care be available. I'll wait to see if that's in there. But that has to be an option as well for the lower-income people.

I don't think there's any realistic hope of a massive government takeover of the health care system in one fell swoop. This is a good start. This isn't the end of the discussion. There will be further steps to go.

I don't see this state being at a place where we can eliminate employer-based health care in one step without a massive tax increase to do so, and no one can get elected to higher office making that proposal. This is the state that 4 years ago came within about 5 points of eliminating the income tax altogether.

I certainly agree that as a candidate and not a politician, it is easy to talk, and not have the responsibility (yet) of action. But at the moment, there's a plan in front of us, a plan that accomplishes some of the major goals in Patrick's health care plan, and it seems to me that only a fool would reject that plan because it doesn't do everything you want.

That would be like a politician who votes against a gun control bill because it sets limits on 9 dangerous weapons and they want the bill to control 10. Take what you can get, and then fight for the 10th in the next go-round. (And no, I have no idea what Deval's stance is on gun control. This is a theoretical example.)

Posted by: Qane | Nov 5, 2005 6:23:59 PM

Hey, the Japanese and the Belgians have the whole enchilada (aka Massive Government Takeover) and they're paying less and living longer. Why can't we?

Posted by: fair deal | Nov 5, 2005 6:48:35 PM

Fair deal, your idealism is admirable. We need people like you around to keep pushing the envelope. Stick around.

If you like single-payer, do you think that the state assuming a much larger role in insuring people (as is certainly being contemplated here) is a step forward? Or a step backward?

Or -- do you not believe in steps at all? And if not, what's your schedule for getting "the whole enchilada" done? Be specific.

Posted by: Charley on the MTA | Nov 5, 2005 7:06:07 PM

Hey, the Japanese and the Belgians have the whole enchilada (aka Massive Government Takeover) and they're paying less and living longer. Why can't we?

Because we drive everywhere, including to McDonald's far too often. Next question.

Posted by: stomv | Nov 5, 2005 8:52:24 PM

Once again, some of us are blaming someone who actually took a big chunk of our position but not our ideal position or process to get there. Talk about biting your nose to spite your face!

From where I sit, this is one of the most aggressive plans we have seen. History tells us, that if we don't get somehting done right now, we will not get another chance for a long long time. Look how far reform fell off the map after Hillary Care. Then look at the awful prescription drug package we ended up with.

Us health care wonks need to stop letting the perfect be the enemy of the good. The alternative is downright dreadful and disasterous. Right now we have a chance to make real reform, not perfect, but real change.

Also, as we talk around Mr. Patrick, Tom Reilly, the supposed Democratic front runner for Governor won't even talk about it. That is far far worse in my opinion. So I ask: what about Reilly's 'no comment'? Does anyone know why Reilly is so silent? What's the story there? Is it purely political strategy, in which case, that is absolutely not leadership but placating to win an election, which is what has cost you Dems election after election in my opinion, and will cost all of us a better health care system.

Posted by: Julie Vickery | Nov 6, 2005 9:48:10 AM

charley, if you're in a wonky mood some evening you can read the entirety of the Health Care Trust legislation here:
I would invite anyone to rip it to shreds. But by my reckoning, it makes a whole lotta sense.
I would be curious to know what the real fears of progressives to this proposal would be. (and for the sake of this discussion, let's say that 'political viability' won't count as an answer. nor will 'it might make an insurance corporation mad'.)

Posted by: fair deal | Nov 7, 2005 12:17:46 AM

Jumping in late here - and playing devil's advocate.

One thing that does worry me about passing this bill as a "step" in the right direction is that the legislature will think "Phew, we did something" and leave it at that, while for the rest of us insured (thank god I can include myself in that category right now) are seeing up to double-digit increases in our premiums, far outpacing inflation or our salaries. In other words, this half measure will, in their eyes, be a huge leap of faith that they took and they will take no more.

But that said, I personally side on the practical (getting those vulnerable people insured, taking baby steps to ease businesses into the idea that they will be expected to shoulder some of this) than the perfect.

Posted by: Lynne | Nov 7, 2005 3:32:42 PM

I should say, the unattainable perfect.

But yes, "other countries pay less and live longer, and why can't we" is a very good question to ask, and must be repeated over and over again.

Posted by: Lynne | Nov 7, 2005 3:34:38 PM

Lynne, this issue will not be done if and when something gets passed. None of the proposals now on board will make things perfect by any stretch. There's a lot more to do on cost/quality control (two sides of the same coin), for instance -- even if they were to miraculously insure everyone.

I'm not going to let up, and I suspect neither will you. :)

Posted by: Charley on the MTA | Nov 8, 2005 2:34:37 PM

It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.

Posted by: California Health Insurance | Nov 10, 2005 5:30:46 PM

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