Beyond Massachusetts

One in six Americans at some point during this year will go without health insurance. Most of them at any given point in time do not need it.

One in ten working Americans are without gainful employment right now. Every one of them wants a job ... right now.

That, as much as anything, explains yesterday's Senate special election result in Massachusetts, the only state in the union that has a health insurance plan similar to ones passed in the House and Senate last year. Were voters there rejecting their own system? Not according to every poll that asks the question. The Bay State has the lowest uninsured rate in the nation; local residents have learned to participate in the insurance exchange set up under its plan (passed under a Republican governor); and people seem to like it.

So any commentary this morning that seeks to make health care reform the scapegoat for voters choosing Scott Brown, an obscure state senator, over an aloof attorney general Martha Coakley, is off the mark.

Massachusetts hasn't solved its health care problem. Its costs are still rising at an unsustainable pace, suggesting the reforms in the national legislation won't solve that problem either.

But moving beyond the insuring-the-uninsured has made cost control the central issue in that state, which it should be. Lower cost care will be better care, a fact that has been lost in the current debate. Reform as defined by the House and Senate bills has largely been about including everyone in a dysfunctional system that delivers poor quality care.

Reformers ultimately need to refocus the debate on the policy prescriptions necessarily to improve the quality and lower the cost of care. But to get to that point, they need to move beyond the question of universal coverage, as they did in Massachusetts.

Therefore, the Democrats who control Congress should do whatever necessary to pass something that achieves that end. If it means getting the House to adopt the Senate bill, which is terribly flawed in many respects, especially in its embrace of schemes like taxing high-cost plans that falsely claim the magic of the market can hold down costs, so be it.

As numerous commentators pointed out this morning, both the House and Senate bills are centrist plans designed to win bipartisan support. Passage of either would require constant tinkering year after year to amend its flaws. Both rejected universal schemes that would eliminate employer-provided care: the left-backed single-payer plan or the everyone-buy-their-own plan proposed by Sen. Ron Wyden of Oregon, either of which makes more sense than the Rube Goldberg machine apparatus preferred by centrists.

So, given the political dynamic facing the Democratic leadership this morning, the best option is to have the House pass the Senate bill. And when the dust settles, probably after the next election, certainly after the economy has improved, the tinkering can begin.