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Mass. Health Reform As Pig In A Poke

Josh Archambault of the Pioneer Institute (Courtesy of JA)
Josh Archambault of the Pioneer Institute (Courtesy of JA)

I had to look up this expression to make sure I was using it correctly, but yes, indeed, the opinion piece in the Boston Herald today from The Pioneer Institute's Josh Archambault argues that the legislature is buying a pig in a poke when it comes to the cost-cutting health reform measures soon up for passage.

(Why we love Wikipedia: The expression means "that something is sold or bought without the buyer knowing its true nature or value, especially when buying without inspecting the item beforehand," and "A poke is a sack or bag. It has a French origin as 'poque.'")

But I digress. Josh warns:

The fact that a bill which overhauls our complex health care system was passed in mere hours without debate should worry all of us. President Calvin Coolidge once said, “It is much more important to kill bad bills than to pass good ones.” Legislators failed to take heed.

The health care cost control bill is a symptom of our current “Facebook” legislative process. It limits deep and meaningful debate and allows members to “like” a bill without understanding it. Taxpayers deserve more.

He expresses particular concern that the bill will undermine the health care industry and cost "billions in unintended consequences." He writes:

The so-called “health reform 2.0” restructures 18 percent of the state’s economy, promises over $100 billion (yes, billion) in savings and changes the rules of one of the largest employment sectors of the state. Yet the House passed the bill almost unanimously (with a mere 7 “no” votes) without debating the bill. To be fair, five of the 275 amendments were debated, but the 188-page, 51,731-word bill was apparently unworthy of discussion beyond that.

The promises for this bill — now being considered by a joint House-Senate conference committee — are historic, according to the rhetoric of the elected officials who authored it. It “completely alters the landscape of our delivery system,” and “will result in an estimated $150 billion in savings over the next 15 years.” “It is going to work because it is well thought out ... It is not going to hurt our best hospitals... We will be the first state in the country to manage the cost-quality conundrum.”

Sounds like a good idea, but what specifically in the bill gets us these promised savings? No one asked. There hasn’t even been a cost estimate done for how much new spending is in the legislation. Yet a quick review of the proposal reveals hundreds of millions of new surcharges, assessments and penalties that will be passed along to consumers. Will gauzy promises of cost savings plus concrete new fees really equal a billion dollars in savings?

Readers? Is this just follow-the-leader politics as usual in Massachusetts, or should the bill in fact have been debated more?

This program aired on July 16, 2012. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth blog.

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