There’s an interesting entry today at the Forbes’ blog The Apothecary, with Avik Roy. Roy, it may be remembered, was the advisor on health care to Mitt Romney’s campaign of whom Paul Krugman wrote: “Roy has to know that he’s making an essentially fraudulent argument — and does it anyway.”
Titled "After Obamacare, Can Don Berwick Implement Single-Payer in Massachusetts?", this particular blog entry fits in with the Roy style even though it was not written by Roy. It’s by someone named Josh Archambault who is apparently a former health policy geek at the Heritage Foundation. Archambault seems determined to try to nip in the bud both the single-payer movement in Massachusetts and the candidacy of its leading proponent, Don Berwick.
Early on, Archambault admits:
“Healthcare accounts for almost 20 percent of the state’s GDP, and employers spend the most for insurance in the country… The state spends over 40 percent of the budget on healthcare related programs.”
One would assume that these facts might suggest to the writer the need to seek improvements and to research additional solutions, as Berwick and others have suggested.
But one would be wrong. More below the fold:
Archambault writes:
“The state has a history of tinkering in health policy, and more recently the legislature has passed major healthcare bills every two years since 2006, most recently culminating in a... law in July of 2012 that sets a growth gap (sic? “Cap”?) on the industry, and puts in place many bureaucratic bodies to ‘fix’ healthcare.”
This writer clearly opposes any government interaction in healthcare, and would undoubtedly oppose federal government actions most of all. But notice how he now “cleverly” reverses field:
“Supporters of single-payer often call it ‘Medicare-for-all,’ which would make sense if this happened at the federal level, but is less clear how you would set up such a system at the state level… First, the federal government would need to grant waivers for all programs that use federal money.”
Why? It seems to me that the administration clearly has the right and responsibility to accept and support state innovations (like single-payer in Vermont!) while rejecting state programs that are detrimental to the goals of the ACA, either intentionally or accidentally. Because the administration chooses to support one state in instituting a single-payer system does not mean that it would have to support another state sending all ACA funding and credits to the state university’s football program! This is obviously the sort of canard that fits in perfectly on an Avik Roy blog.
He continues:
“The waivers required range from Medicaid to the tax credits that were targeted for those buying insurance in an exchange. However, if the Administration approves these waivers, they should be approving any Medicaid waiver coming in from other states as well.”
Again, why?
But to me, the key feature of this blog post is its attack on Don Berwick. The writer points out, correctly, that healthcare is a big issue in this race and that six of the announced candidates have healthcare connections. And he slyly slips in what he regards as negatives about Berwick’s positions and experience: “(H)is controversial tenure in DC” (controversial only to the anti-ACA wingnuts who, as with Elizabeth Warren, filibustered his appointment); “his devoted following on the left” (because progressives are so unpopular in Massachusetts, I guess); “he desires a single-payer system in America” (um – so?).
He also slyly previews an attack that Berwick is likely to see more and more:
“(H)e distances himself from the ‘staff-level’ dire implementation of his ‘majestic’ ACA.”
The fact that Berwick resigned from CMS and returned to Massachusetts twenty-two months before the Healthcare.gov website rollout does nothing to stop this sophist from trying to draw a link. Anyone with knowledge of systems project management knows that there is zero relationship between a system rollout and anything that happened almost two years earlier. A drug development project, undoubtedly; mall construction, maybe; but not a website. The project lifecycle is simply not that long – no detailed schedule could possibly have been developed in 2011.
Of course that won’t stop these scumbags from their attacks.
Then we get to what I believe is the heart of the matter:
“The Massachusetts Democratic Party has endorsed a single-payer plank in its platform, and Berwick is the highest profile candidate to endorse the idea so far.”
That’s it! It’s very interesting that the GOP mouthpieces are clearly seeing Don Berwick’s candidacy as a serious threat. And they should.