The other day, I argued that it will be hard to take the Republican party seriously until potential presidential candidate Mitt Romney can use Massachusetts health-care reform as a selling point, instead of downplaying his biggest accomplishment as a public official. That, in turn, depends on whether or not Mass Care is succeeding, and Ramesh Ponnuru argues that the model is not in an article about Romney. Now, Ponnuru's replied to my criticisms, and he still doesn't quite get it, suggesting that I'm not actually disputing the points he makes. Let's break it down:It doesn't bend the cost curve!: Ponnuru thinks these ideas are just nice words. But he cuts the second half of my sentence in his quote -- tsk, tsk, cherrypicking! -- which points out that you can't adopt cost-cutting policies without the framework provided universal coverage. Without the information that comes from having everyone in the system, the economies of scale, and the ability to eliminate waste like people using the emergency room as a clinic, you can't have cost-cutting. It's a basic lesson on health-care reform that almost any health policy expert will tell you, and Massachusetts is well ahead of the rest of the country on that front. It's costing money! Though experts think the plan isn't bankrupting the state, Ponnuru believes it's a problem that "the state picks up only a fifth of the costs the plan generates." But that is true of any universal health-care plan! Eliminating inefficiencies in the insurance market and bargaining with pharmaceutical companies should be part of saving costs, unless Ponnuru thinks that private insurers are making too much money. More importantly, the Massachusetts plan was in part a success because it got more people to use employer-provided health insurance rather than public subsidies, something you'd think a conservative would support. Along with people getting their own health insurance, the federal government should contribute to health-care costs for people on Medicare, Medicaid and in the VA system. The fact that Romney and his Democratic legislature could design a plan that doesn't require massive state government spending should be a point in its favor.It's not popular! Over a year where wild attacks on health care-reform have been a constant refrain, the popularity of the plan dropped from 68 percent to 59 percent. Gosh, what a terrible plunge. 59 percent approval is something almost any politician or public policy would kill to have -- especially in the GOP. Some things that don't have 59 percent public approval: Sarah Palin, John McCain, Mike Huckabee, Republicans in Congress, and, yes, Mitt Romney himself. Maybe he ought to take more credit for Mass Care ... Wait times! The fact that it's harder to find a primary care physician in Massachusetts is influenced largely by the shortage of primary care doctors in the United States. But it's also a sign that health-care reform is working -- lots of new people are going to see the doctor, and it's no surprise that it will take time for the system to adapt. If Ponnuru wants to make the argument that we should ration health care by income, so that people who can't afford insurance won't have regular access to medical care, I look forward to it. So, yes, I do think I'm disputing Ponnuru's points, and I think I'm right! That's not to say Mass Care is without it it's problems, but on the whole it's a success. And I stand by my original point: If Romney can't campaign on a cheap, bipartisan health-care overhaul, the GOP is going to have a very hard time indeed. -- Tim Fernholz
