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With health care reform, few get their first choice

By Robert Bazell, NBC News Chief science correspondent

The blog I wrote yesterday about the first of two reports on Massachusetts' health care reform effort generated a large number of clicks and many thoughtful responses online. Some of the comments came from people in the bay state who said the system was not working, while others form Massachusetts and elsewhere praised it.

As I pointed out, the officials in Massachusetts see their effort as an experiment.  It is notable because that state has done far more than any other to get more people covered.  Anyone thinking about reforming health care, as the Obama team and many in Congress have promised,  has to look at the Massachusetts experience, whether they adopt its provisions or not.

Starting with FDR, presidents have attempted and failed to bring health coverage to all Americans.  They failed in the early days because of fierce opposition from the American Medical Association and more recently because of the large number of special interest groups, including insurance companies and pharmaceutical manufacturers, that profit from health care.

For all of its problems, some of which we highlight in tonight's report, the Massachusetts plan intrigued me because many of those involved pointed out that the plan came about through serious compromise. In the past, many people hoping to reform health care have demanded to do it their way--whether that was a single government-run program for all or a totally free-market system where everyone pays out of pocket.  If the reformers did not get their way, the result was that the status quo remained--and it did.

But we know that today, even though many Americans are satisfied with their health care, the system overall costs way more than we as a nation can afford  and leaves too many people with inadequate care. The status quo is frightening  option. 


In Massachusetts, the plan that ultimately emerged was no one's first choice. But many people came together and accepted their second or third choice.
In another recent report I noted that many experts see a very narrow window for national health reform from the Obama inauguration before politicians start to focus on the next mid-term election. Drew Altman, head of the Kaiser Family Foundation, pointed out that "There is a very special moment right now, and the question is whether the President and the Congress will be able to take advantage of that moment of opportunity or whether we'll miss the window of opportunity once again."

In an upcoming article on health reform in the New England Journal of Medicine, Dr. Victor Fuchs of Stanford offers a quote by Niccolo Machiavelli from 1513: "There is nothing more difficult to manage, more dubious to accomplish, not more doubtful of success," Machiavelli wrote, "than to initiate a new order of things.  The reformer has enemies in all those who profit from the old order and only lukewarm defenders from those who would profit from the new order."

Those words still apply to the efforts to reform health care in Massachusetts and elsewhere today. It will not be easy.



   Click here to watch the related video report from NBC's Robert Bazell.