"The Commission Felt It Was Neccesary."

by Conor Friedersdorf

Ezra Klein writes:

In 2006, Massachusetts passed a big health-care reform bill. The structure of it was actually pretty similar to what we're seeing nationally. And, like what we're seeing nationally, it didn't have much in the way of cost controls. But nor did it promise to. The short-term priority, officials said, was getting coverage to everyone. The long-term priority was cost control. And the two would work together.

After all, without cost controls, subsidizing health-care coverage would become unaffordable, and Massachusetts would have to abandon the reforms it had worked so hard to pass. Without cost control, there could be no universal health-care system. That would focus the mind, they predicted. That would help them make the hard decisions.

This theory made some sense, but it was never clear if it would actually amount to anything. But now Massachusetts is trying to move away from fee-for-service medicine, and towards a payment system that doesn't push doctors to maximize their income by maximizing their treatments.

That's a huge reform. Much bigger than anything we're considering nationally. It's a direct attempt to change the behavior of politically powerful providers to preserve the coverage that the reforms gave to individuals. It will be difficult. The doctors' lobby is already giving angry quotes to the press. But the vote on the commission was unanimous. And the members of the commission felt it was necessary. After all, the only choices before them were going forward on reform and going backward. The status quo was no longer an option. That wasn't been true before reform. But it's true now.

So if we pass health care reform on the national level, it'll start out as something that passes muster with voters, but will eventually morph into a system where technocrats can subvert the popular will by reaching consensus opinions that are insulated from political accountability? Or am I misunderstanding Ezra's point?