Healthcare hopes fade
Perhaps the notion of sweeping healthcare reform led by the Massachusetts Legislature was always too good to be true.
That's certainly the way it's starting to look, given the announcement over the weekend by Senate President Robert Travaglini that dreams of full coverage probably will have to be scaled down to get a bill passed in time to meet a deadline for federal funding.
For many months now, leaders of the House and Senate and Governor Mitt Romney have all indicated that they are ready to overhaul the state's healthcare system to insure the currently uninsured. The problem, as always, resides in the details.
The House plan would cover the largest number of the uninsured, but would require employers who don't insure their workers to pay into the system, an idea that Romney and Travaglini strongly oppose. Supporters of the mandate say it is the only way to provide universal health coverage. The plan offered by Travaglini would cover far fewer people.
Healthcare has been so obviously in need of reform for so long that Travaglini, Romney, and House Speaker Salvatore DiMasi deserve credit for taking it on.
Unfortunately, they have all been so busy patting themselves on the back for their vision and courage that they haven't been able to actually pass anything.
What a sad moment. While healthcare overhaul always figured to be difficult to pull off politically, there's no excuse for this failure. Everyone will blame everyone else. All of them will be, to some extent, right.
While Travaglini says the idea of sweeping reform appears dead, in fact, he has always considered full coverage unattainable.
''The Senate is pulling away from something it never embraced," John McDonough, executive director of the advocacy group Health Care for All and a former state legislator who favors employer mandates, said yesterday in a phone interview. ''I'm hard-pressed to think of a time when [the Senate] really supported major reform."
There's one urgent reason why some kind of bill will be passed this week: money. Some $385 million in federal cash is dependent upon the state meeting regulations to take steps to cover more of the uninsured. That money could be in jeopardy if a new program isn't in place by July, and it's far too much to lose.
Still, there's sweeping change, and then there's incremental change. And in the face of a system that clearly needs a major overhaul, incrementalism is going to win if Travaglini is taken at his word.
This is leadership?
It's not that no one has tried. Romney has attempted to push the Legislature into doing something -- partly as a credential for his expected presidential campaign -- and many legislators believe this is the time to address a longstanding problem. But what does it say when the governor and both houses of the Legislature agree broadly on the need to fix a major problem, but still can't figure out how to do it?
The headlines they have garnered have been bold, but the actions have been increasingly timid. It doesn't inspire much hope for the finished product.
This is a debate with real consequences. As many of the uninsured have come to use emergency rooms for primary care, the cost of the free care pool, which reimburses hospitals for care that isn't covered by insurance, has skyrocketed. At the same time, concern has been mounting about the thousands of residents who go to work every day but still lack insurance, a problem that afflicts a broader range of people than commonly assumed.
Only a fool would bet on what the finished healthcare bill will look like, though full coverage seems the least likely outcome.
One thing is likely, though: Whatever is passed, no matter how short it falls of what might have been, our lawmakers are sure to congratulate themselves.
Adrian Walker is a Globe columnist. He can be reached at walker@globe.com. 