But despite all the plaudits Massachusetts is getting, donít expect this kind of plan to become national policy anytime soon. In Washington, there is very little political will to deal with such an enormously complicated issue one that, as the Clintons learned the hard way in the 1990s, has numerous fault lines.
Itís not that the Massachusetts model, requiring all individuals to have coverage, is a radical idea. In 1994, when the Clintons were trying to reform health care by requiring employers to insure their workers, the late John Chafee, a Republican Senator from Rhode Island, proposed a similar, so-called "individual mandate," which more than a dozen of his Republican colleagues supported. The other parts of the Massachusetts initiative, such as increasing tax credits and getting more children enrolled in public programs, have gotten support from Republicans such as Senate Majority Leader Bill Frist and Democrats like Senator John Kerry. And unlike other issues, where Democrats and Republicans approach them as if they are from completely different planets, both parties largely agree that rising health care costs and a growing number of uninsured are big problems.
But Washington's reluctance to deal seriously with health care reform in many ways reflects the publicís ambivalence toward the problem. Like education, voters always say health care is an issue very important to them; a Gallup poll last month found 68% of people worried "a great deal" about "the availability and affordability of health care." But in a poll this month, when CBS News asked "what is the most important problem facing this country today," five percent said health care, much lower than immigration (13%), the economy (13%) and the war in Iraq (27%).
And if the polls give politicians less incentive to tackle health care, the potentially prohibitive cost really seals the deal. In his State of the Union address, President Bush called for expansion of health savings accounts, which require consumers to pay more of care expenses out-of-pocket but allow money not spent on health care to grow in tax-free accounts. But Republicans on Capitol Hill have balked at spending the billions in tax incentives Bush wants for the accounts. Creating tax subsidies so that everyone in the country could purchase health insurance, as some in both parties have called for, would cost hundreds of billions of dollars, at a time when the deficit has ballooned and conservatives are demanding spending cuts.
Of course, three years ago, at a time when that deficit was already growing, Congress passed a Medicare prescription drug benefit that costs more than $400 billion. The difference then was that seniors, unlike the large number of Americans concerned about high health care cost and access, are a highly organized and powerful voting group that pays close attention to health care issues.
What could change the health care discussion is big business. Democrats have long championed expanding health care by putting more people on federal government plans like Medicare and Medicaid, while Republicans have argued health care already suffers from too much government intervention. But as companies like General Motors suggest that paying for the health care of their employees hampers their ability to compete in the global economy, both parties may someday find common ground on the issue.
In the middle of an election year, both parties are approaching health care mostly as way to, what else, score political points. Next month, the Senate will likely debate a GOP-backed provision to cap damages from malpractice lawsuits. While studies suggest malpractice reform does little to reduce health care costs, trial lawyers (who back Democrats) and insurance companies (who favor Republicans) are pushing senators toward a fight. And while Democrats will roll out a health care plan later this year, their main theme will be attacking the prescription drug bill that has now gone into effect. All of which shows that no matter what happens in innovative states like Massachusetts, Washington will continue to be a symptom of the ailing health care system rather than any kind of cure.