Understanding the national health-care reform debate

Professor Parmet is a public health law expert. Photo by Craig Bailey.

August 20, 2009

Reforming the nation's health-care system is a top legislative priority for President Obama. Over the past few years, Massachusetts has reformed its health-care system, requiring all state residents to carry insurance or be subject to penalty. Not all agree that this state model should be the basis for a national system. Wendy Parmet, Matthews distinguished professor of law at Northeastern University’s School of Law, addresses some of the key questions in the health-care reform debate.

Massachusetts is the first state in the nation to enact a law requiring residents to have health insurance. Many are wondering, is health-care reform in Massachusetts really working?
In most ways, health-care reform is working in Massachusetts. The number of people without insurance has dropped dramatically, and recent studies show that costs have not proven as much of a problem as some feared. Still, the Massachusetts model is not perfect. The state chose to focus on access before addressing payment reform, which means that some difficult decisions remain. And, Massachusetts, like all states, has experienced a major drop in state revenues due to the recession, which has placed a significant strain on reform. Yet, the basic durability of reform is a testament to its overall success.

Do you think that this model should be used as a basis for the nation's health-care reform?
The Massachusetts approach has much to offer the nation, which is why many of the bills now being debated in Washington borrow from it. However, it is important to remember that Massachusetts began its reform efforts with a lower percentage of uninsured citizens than exists in most states today, and it has not yet dealt with many of the difficult cost-savings issues. The federal government can and should learn from Massachusetts, but federal reform should not simply mirror the Massachusetts model.

Every industrialized country except the United States has some form of universal or near-universal health insurance. Is this something that the federal government is considering?
In countries such as Canada, there is a single-payer system, which means that citizens use health insurance provided by the government to obtain care from physicians and providers in the private sector. In other countries, the government regulates the insurance market and provides some mix of public insurance and subsidies for those who otherwise could not afford insurance. The latter is what is being discussed in the U.S. There is no doubt that the system we end up with will include a mix of public and private options. After all, today, some people have private insurance; others, like seniors, have public insurance. And while most people obtain their health care from private institutions, others, including many veterans, use public health-care providers.

It is estimated that a new, national health-care reform package will cost upwards of $1 trillion. Given our federal deficit, can we afford this? 
We must deal with health-care costs; health-care reform needs to tackle that problem. On the other hand, health-care costs today constitute a growing part of the existing deficit, and they pose a major strain on the budgets of states, families, and businesses. So, while reform is expensive, we can't afford to do nothing.

How long do you think this reform process will take?
It is likely that we will find out by the end of the year whether reform will be enacted. If it isn't enacted this year, it may take the election of a new president.

How will this health-care reform affect middle-class America? 
If reform passes, most middle-class Americans who have health insurance are apt to keep their current plans. However, they will no longer be vulnerable to losing their health insurance if they become sick or lose their job. Depending upon how effectively reform stems the costs of health care, Americans may see their premiums rise less steeply than they otherwise would.






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