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November 11, 2005

Six health care op-eds

The Globe published a nice collection of six short op-eds on health care today, each from a different perspective.  The authors are Gerald Algere (a businessman and board member of Greater Boston Interfaith Organization), Charlie Baker (CEO of Harvard Pilgrim Health Care), David Barrett and Ronald Hollander (both of the Mass. Hospital Association), Christopher Anderson (president of the Mass. High Tech. Council), Joseph Newhouse (a professor of health policy at Harvard), and Phil Edmundson (a businessman and founder of Mass. Business Leaders for Quality Affordable Health Care).

A couple of observations.  First, not one of the op-eds even mentions an individual mandate, much less urges that an individual mandate is a necessary part of fixing the health care system.  As anyone who's been reading our health care posts already knows, I don't like the individual mandate idea, and if we can get a good health care bill through without it, so much the better.  The big bone of contention now appears to be the employer "pay or play" provision - as it should be.  Let's hope the lousy idea of forcing people to buy products as a condition of living in this state ends up quietly slipping onto the cutting room floor.

Second, the one op-ed that aggressively objects to employer "pay or play" - Anderson's - is both unconvincing and somewhat disingenuous.  For example, Anderson loudly trumpets the fact that the House's original bill might have taxed employers who already provided health care - without mentioning the fact that this was an error, and that the bill the House actually passed does not have the problem.  They fixed it, Mr. Anderson, or didn't you notice?  Also, Anderson claims that the House bill is "eerily similar" to a ballot initiative that supposedly is heading for the "Canadian system," and at the end of his piece describes what's happening now as a "push for universal or single-payer coverage."  Without getting into whether the ballot initiative has any Canada-like features, we can state categorically that to compare the House bill to a Canadian-style single payer system is, in a word, stupid.  The defining feature of a "single payer" system is that - surprise - it has a single payer (normally the government).  The point of the House bill, in contrast, is to make it more likely that individuals will be covered either by private insurance or by government-sponsored programs for low-income residents.  That, of course, is exactly the system we have now - we'd just have more of it under the House bill.  That's called expanding access.  It's certainly not called single payer.

Anderson, in fact, is so against employers having any responsibility for health care whatsoever that he can't even get on board with the Senate's comparatively mild proposal to bill employers who don't provide coverage when their employees utilize the free care pool, fearing that in some unexplained way it would become a "back-door tax" on employers who already provide coverage.  (Huh?)  Anderson, in other words, doesn't want employers to be responsible for health care.  But he also doesn't want the government to do it (since he's obviously against "single payer").  So I guess he favors the "you're on your own" approach. 

The really remarkable thing about Anderson's piece is how totally he fails to engage the arguments in Algere's, Newhouse's, and Edmundson's pieces to the effect that employer "pay or play" actually benefits most businesses who are doing the right thing - it levels the competitive playing field by taking away the advantage that businesses who don't provide health care currently enjoy, and it actually means that businesses who already provide health care will see their costs go down.  I'm not going to rehash the details of those arguments here - I've talked about them before with Phil Edmundson, and the op-ed pieces themselves lay out the argument better than I can.  But I will offer one quote from Newhouse's piece: he explains that under the House bill, employers who do not presently offer health care "in fact would become less competitive .... The flip side, of course, is that firms now providing health insurance would become more competitive in the labor market."  Q.E.D.

Maybe the Globe is trying to skew the debate by having as their token "anti-pay or play" advocate someone who they expected would make weak and disingenous arguments.  I don't know - although you'd think that if Charlie Baker (a Republican and fiscal conservative) really objected to pay or play, he would have used his space to express that view, but he didn't, focusing instead on fairly technical issues.  In any event, if the best the "anti-pay or play" crowd can do is what Anderson wrote in today's Globe, that side should, and hopefully will, lose.

Posted by David at 10:45 AM in Health Care, Massachusetts | Permalink


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I am a little concerned because Baker's piece was one of the best. I usually don't like to agree with Republicans. I too thought Anderson's piece was disingenuous. He is trying to ring alarm bells for things that aren't very likely. I am happy to have talk of an individual mandate fade away because it is just cruel. Although I do think it was alluded to when Algere said there ought not to be "penalties for the most vulnerable."

Posted by: Andy | Nov 11, 2005 12:58:08 PM

Great rundown and rebuke, David (I had to double-check who wrote this post - normally it would be Charlie). :)

Posted by: Lynne | Nov 11, 2005 2:09:06 PM

David said everything I wanted to say about Anderson. I'll have more about Baker later today -- it's a great column.

Posted by: Charley on the MTA | Nov 11, 2005 2:30:28 PM

Re Baker: I agree it's a very good column. As I've said on other occasions, Baker is a smart guy who knows a lot about health care. We should all listen to what he has to say - even if he is a Republican!

Posted by: David | Nov 11, 2005 2:55:09 PM

Anderson is extremely disingenuous and very irritating. Don't mpst high tech employers provide healthcare anyway? I wonder why he feels so strpngly about this issue. It would seem to me that most of the employers he might represent would benefit from the House's proposal since they would no longer have to pay the free care pool surcharge.

Posted by: Abby | Nov 11, 2005 5:36:30 PM

If I have to pay a $7,000 bill when an employee uses the 'free care pool' because I'm on my wife's insurance, and the new employee tells me they are insured elsewhere too, I want a clause in the bill that lets me either force them to provide ME with proof of coverage elsewhere, or lets me have them sign a binding waiver releasing me from any debt.

How in the HELL am I supposed to be able to tell if an employee really has coverge or not, when they say they do, and I don't want to buy a policy with no takers?

Posted by: Business Owner | Nov 14, 2005 3:29:54 AM

Our health care system really does have some major problems in which we need to resolve.

Posted by: Blue Cross of California | Nov 22, 2005 6:14:57 PM

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