Massachusetts Healthcare Goes National

The MIT economist, Jonathan Gruber, who consulted on the creation of the Massachusetts healthcare reform plan and who is now working with California on their plan has released a nationalized version of the Massachusetts model.

I’m very impressed with what they’ve been able to pull off politically in Massachusetts, but I do have some serious concerns:

First, it seems to me that before we all agree that the boys and girls in Massachusetts have cracked the proverbial nut, we ought to give their plan a few years of practice to see how it all plays out. I realize no one wants to wait that long, but it’s important to wait for the experiment to be fully implemented before declaring it a success.

Second, I have some doubts about the idea of state purchasing pools for individuals not covered under employer plans. The (perhaps unanswerable) questions I have are:

1. Will insurance companies view these as bona fide risk pools or will they essentially consider it the individual market? Sure, the proposal calls for community rating and guaranteed issue, but that still leaves the door open for individuals to pay more and get less than members of a large employer group.
2. Can we count on state purchasing pools not be manhandled by the insurance companies? If you look at cases where states have contracted with private insurers to provide Medicaid services, the track record isn’t great.
3. Do individual purchasers have any real advocate, or are they essentially left to face the bureaucracy on their own? Will the state pools be able to serve as “intermediaries“?

Until some of this stuff is made clearer (at least to me) I’m still unsold on the Massachusetts model.