"Health Reform at One Year - A Litte Perspective" by John McDonough

An unprecedented ideological divide over Massachusetts health reform congealed one year ago.

On the political left, a cleavage emerged between those who thought Chapter 58 the worst thing imaginable, a sheep in wolf’s clothing to speed up the demise of employer sponsored coverage and to promote consumer driven policies – an argument advanced by the AFL-CIO (state and national), single payer advocates and others.

Others on the left – the ACT Coalition, Families USA and others – suggested Chapter 58 represented a noteworthy and promising advance, risky and unprecedented, and worth pushing as far as possible.

On the political right, a similar split. One side, represented by the Cato Institute, the Wall Street Journal editorial page, Sally Satel and others attack Chapter 58 as a wolf in sheep’s clothing for single payer, an advance for government controlled health care, and a whole lot worse.

The other part of the right, represented by the Heritage Foundation, Newt Gingrich, and Mitt Romney (until recently), sees a lot to like, finds merit in individual responsibility, and is open to seeing how it can go.

With the notable exception of Romney, everyone’s still in place. Those who hated Chapter 58 one year ago, hate it today. God luv ‘em – they keep the law’s defenders on our feet, challenge us at every step, never let us get complacent. Keep it up, thank you.

And, every group that was part of the coalition supporting the law’s creation is still at the table, compromising, doing the best we can to make implementation work. That says something, and that’s worth something.

As the Connector considers the monumental decision it will make on Thursday defining enforcement parameters for the individual mandate, the policy substance matters, and so do the politics – to enable everyone who wants the law to succeed to continue support.

Recently, Nancy Turnbull created a funky Alexander Calder-type mobile to illustrate health reform, with components of the law as floating colored artifacts. It’s more apt than she realizes. Chapter 58 was the product of a moment in Massachusetts political and health policy history – Bush Administration funding threats compelled action by the Democratic legislature and the Romney Administration. It would not come out the same way today – no way. Just as politics is more art than science, so is Chapter 58.

Lots of folks look at Chapter 58 and say, “ugliest piece of s___ I ever done seen!” Others look and say, “Not too shabby. We could have done worse. Let’s figure out how to use it the best we can, and then figure out next steps.”

That’s where we are today. Happy birthday, Chapter 58.

John McDonough is the Executive Director at Health Care for All