Universal Health Care

Today's NY Times leads with the story of how Massachusetts has now adopted a nearly universal health insurance plan. In many ways, the plan is quite creative. It requires everyone to carry insurance or be penalized on their income taxes. It requires almost all businesses (except for those with fewer than 10 employees) to carry insurance for their employees, and it subsidizes the cost for those individuals deemed unable to afford coverage.

From what I can tell from the article, however, it fails to do some things that I believe are absolutely necessary. First, it seems to me it's necessary to do away with special group insurance rates. Every insurance company should be required to offer any plan they sell to all comers at the same price, regardless of their affiliation with a particular group. Without such a provision, small businesses, self-employed individuals, early retirees, and the unemployed are left completely out in the cold, spending two or three times as much for coverage as those in large group plans. That means the State will be paying more than it needs to to cover those among this group that require subsidies.

I suppose doing this would never have survived a Mitt Romney veto, since the insurance companies would have howled, but it's the only way I can see to avoid the culling of high risk customers that the insurance companies struggle to achieve.

Second, I frankly believe the only way to really reduce (or at least minimize the growth in) the cost of health insurance is to move to a single payer system. The Massachusetts plan takes no steps in that direction. Nor, it seems, does it put any other restrictions on insurers.

Even given these defects, however, the plan sounds like a good start to me.