Thursday, October 19, 2006
The Devil Can Wait
BY GREGORY E. KAEBNICK
FORUM EDITOR

For a decade or so after the failed Clinton effort at health insurance reform, the subject was considered just too hot and dangerous for politicians to bother with. Recently, however, health reform has seemed possible again, only now the states are leading the way. The most dramatic of the new efforts is the Massachusetts’ health reform plan, which has been hailed as mixing and matching ideas from the left and the right and hammering out a compromise somewhere in the middle – a fundamentally market-oriented plan that also incorporates constraints on the market and subsidies for buyers. The political exchanges were calculated and sometimes combative, and the eventual compromise grudging and qualified (in the end, governor Mitt Romney vetoed one element of the plan and the legislature responded with an override). Still, there’s something new going on in health insurance reform when the Heritage Foundation gives even measured approval to Massachusetts’ Democrats – even if only for being able to follow the lead of the Republican governor. A perspective piece in the New England Journal of Medicine that appeared the week Romney signed the measure into law concluded that “all sides believe they can live with the compromise.”

Maybe. A set of essays we solicited for the current issue of the Hastings Center Report suggests that Massachusetts’ reform effort is very far from winning everybody over. The lead essay, by Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who advised the state on the reform, offers a vigorous defense of the plan, but a couple of the accompanying essays conclude, on the basis of very different arguments and political agendas, that the plan is all but destined to fail.

Some of the criticism, in these essays and elsewhere, is of the mixed and matched pieces. But perhaps the more telling criticism is about gaps in between these pieces. The devil is in the details, and many of the details are just missing. Several commentaries note, for example, that though the reform seeks to make health insurance affordable and even requires all Massachusetts citizens to buy health insurance if it is affordable, what “affordability” means is not specified. In short, not only is the plan a compromise; it also procrastinates. Part of the plan is that there is much more compromising still to be done. On the basis of what’s actually in the reform plan, we may not know yet whether we can all live with it.

But there is still reason for hope, and in fact, the procrastination itself may turn out to be a good thing. James Sabin, coauthor with Norman Daniels of the book Setting Limits Fairly: Can We Learn to Share Medical Resources?, wrote in his essay that he was bullish on the plan because, even though it leaves much to be resolved, it establishes a “promising construct” for working through the many remaining issues “in an open, accountable manner.” The key part of the construct is a board called “the Connector,” whose members are appointed by elected officials but can then function independently – in a manner reminiscent of the Federal Reserve Board. Thus, Sabin wrote, it just may reach the holy grail of making decisions that Massachusetts citizens regard as “disappointing but fair.”

Everybody wants to know whether the plan’s mixed and matched parts provide a model for reform in other states, or even nationally. But it may turn out that the reform’s real genius is that it lifts some of the reform effort away from politicians and give it to someone who can carry it out more effectively.

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A Phony 'War on Science'
Michael Gerson, Washington Post
“In their talk of a Republican war on science, liberals may be blinding themselves to a very different kind of modern war in which their own ideals are deeply implicated: a war on equality.”

It’s Not Immoral to Want to be Immortal
Arthur Caplan, MSNBC
“Despite a lot of hand-wringing and finger-pointing, it is not obvious that wanting to live a lot longer is evil or immoral.”

Science Is Leading Us to More Answers, but It's Also Misleading Us
David A. Shaywitz, Washington Post
“Consumers of scientific information must balance the hope we place in global biology with the skepticism this field has surely earned.”

Taking the Scary out of Breast Cancer Stats
Carol Tavris and Avrum Bluming, LA Times
“The media understand how deeply women fear breast cancer, and the result is that every study that seems to find a link between some new risk factor and the disease makes headlines everywhere.”

Dollars to Doughnuts Diagnosis
Albert Fuchs, LA Times
“Insurance doesn't make routine care affordable; it makes it more expensive by adding a middleman.”

Tainted Medicine
Jerome P. Kassirer, LA Times
“Disclosure of financial ties may give a scientist or researcher a clean conscience, but that doesn't erase the possibility of a conflict.”

Children's health can't be left to faith alone
Arthur Caplan, MSNBC
“Parents do not have the right to watch a child wither away while they pray.”

Transplant List Numbers Raise Doubts
Arthur Caplan, MSNBC
“The American people have a right to expect absolute honesty about the number of people waiting for a transplant at any time.”

An Epidemic No One Wants to Talk About
Robert E. Fullilove et al., Washington Post
“Simply put, we will never rid the United States of HIV and other STDs if our only weapon is medical treatment.”

Making Cells Like Computers
Erik Parens, Boston Globe
“Conceivably, we are on the verge of installing synthetic genomes in bacterial cells to create products we want. But we are still a long, long way from doing what most people mean by ‘synthesizing life.’”

Miracle Workers?
David Rieff, New York Times Magazine
“Even today, the oldest of all relations between patient and physician — that of supplicant to shaman — continues to exert its authority.”

Overselling Overmedication
Judith Warner, NYTimes.com
“Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them are being medicated for largely fictitious concerns.”

Ads Spur Urge for Drugs
David Lazarus, LA Times
“DTC advertising has turned prescription drugs into just another gotta-have-it consumer product.”

Food Politics, Half-Baked
James E. McWilliams, New York Times
“Lost in this rhetorical battle was a quiet middle ground where the benefits and drawbacks of genetically engineered crops were responsibly considered.”

Perpetrating the Autism Myth
Benjamin Kruskal and Carole Allen, Boston Globe
“The scientific evidence is clear: neither the MMR vaccine nor thimerosal (mercury) in vaccines has any relationship to autism.”

Closing the Barn Door After the Cows Have Gotten Out
Verlyn Klinkenborg, New York Times
“The real beneficiaries are the nation’s large meatpacking companies — the kind that would like it best if chickens grew in the shape of nuggets.”

Human Embryos Cloned: What Does It Mean?
Art Caplan, MSNBC
“Let's not be frightened by scare tactics into not funding research that may be the key to curing what is currently incurable.”

Don’t Ask, Don’t Tell Is Bad Policy for Cloned Food
Art Caplan, MSNBC
“All of this fear-mongering about clones has made Americans forget that cloning is nothing more than artificially creating twins.”