The 800 Pound, Obese, Gorilla in the Room

In 2006 Massachusetts mandated that just about everyone in the state be offered health care that was going to be run through the state government paid for with taxes on businesses. It was a radical plan to increase coverage, and it was pretty widely hailed on the Left as a great idea and on the Right as something straight out of Revelations. Of course, neither event seems to have happened as this piece in today's Times shows.

Instead of a wonderful fairyland full of hospitals staffed with friendly doctors or a hellish wasteland created by some beast with 666 (or maybe 616 apparently) stamped on its head strolling around, it's expanded coverage, but at a substantially increased cost. And that's left the politicians wondering where to get more cash and where to save money.

And that brings me to the only thing I know about what will happen if the government "provides" health care. Here's the key quote from the Times piece:

Some health policy experts argue that changes in payment practices will not be enough to slow the growth in spending, even when combined with other cost-cutting strategies. To truly change course, they say, the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care.

“Really controlling costs requires just stopping spending,” said Stuart H. Altman, a professor of health policy at Brandeis University.

No one on either side of this political fight wants to admit it, but here's the truth. Reform will mean changes. If you're uninsured or underinsured now, you'll be better off - full stop. If you are insured, paying a ton, and don't have any particularly exotic problems, you'll probably be better off in terms of costs, but you will have to wait longer to see doctors and specialists. If you have serious problems, or really like your coverage now, you are going to be worse off. You can't have it all. In short there will be trade-offs as the folks in Massachusetts are finally finding out.