Well, this is the great issue of our time. We're currently looking at a federal "reform" that seems to be based on the Massachusetts plan of requiring individuals to buy insurance, subsidizing lower income people, and offering a number of cheap plans for people to choose from.

Unfortunately, this morning our State Treasurer called for the repeal of the Mass plan which is bankrupting our state and while that's only one voice, the legislature is making cuts to it that will reduce the number of people covered. It's turned out to be far more expensive than expected, has done nothing to lower costs for everyone else, and the latest research is that people with the low priced plans are still avoiding routine care and going bankrupt from health expenses because the deductibles and co-pays are just too high.

The big differences I see between what they're talking about federally and what we have here in Mass are the employer mandate and the public plans.

Here in Mass, Mr. Romneys great contribution was to reduce the penalty for companies that don't cover insurance to $295/person which is trivial--likely less than you'd pay for a single month of insurance. the last federal thing I saw was going to penalize employers 8% of payrolls costs which is significant even if below the 10% of payroll costs that insurance averages. This should, in theory, force more employers to offer insurance.

The second difference is the "public plan" Our Mass system has a bunch of cheap basic insurance plans offered by the private sector that people can choose from. The federal plan is to include similar plans plus a public plan based on medicare. The conservatives say this is a trojan horse for a single payer system and would drive private insurers broke because they can't complete--apparently oblivious to how this contradicts the conservative ideology that the private sector is more efficient. The big difference here is really likely to be if the public plan is available to businesses and how easy it will be to access it. If it is available, then it's going to be a real option because it will work better. If it's not available to business, then it's not going to lead to anything.

I'm not sure how I feel. I don't think the public plan idea is a trojan horse or at least I'm sure that the Congressional Goposauruses and their "moderate" fellow travellers won't let it be. The possibility that it might be is really the only thing I can see good about any of this. But with the deficits skyrocketing, I'm not sure we can afford to let a Mass style plan fail long enough for a "public option" within it to be a full public health system. Other than the possibilty of a public option that will simply eat the rest of a failed system, I just don't see that anything proposed at the moment is reform in any way. It's just throwing money at a broken system. It's just going to take the current system of business and individuals (and Massachusetts) going bankrupt from care and extend that bankruptcy to the federal government.

If we aren't going to have a real shot at a sensible single payer plan, I would just as soon see nothing get fixed and the system get worse until maybe we finally get our heads out of our asses and go for a real health system.

To say the least I'm not optomistic. I really agree with Obama's general assertion that we've run out of time and this has to be something we do. But just passing something and calling it reform isn't really a help if it doesn't solve the real problems.