Health care when you can find it

The biggest paper here in Western Massachusetts has a story today on the Bay State's state-run health insurance plan. It turns out that "access" and "insurance" are two different things: "Obstacles block reform efforts"

There is now near universal health coverage in the state, but, here in Western Massachusetts, reform to date still means only one managed care organization in some areas for Commonwealth Care members, fewer than a dozen community health centers in the region and a public transportation system that can make it arduous for some low-income residents to get to their doctor.

"There are definitely more people who are covered with insurance, and have an insurance card, which is a good thing," said Suzanne Smith, director of health services for Northampton-based Tapestry Health. "But, that's not to say there still aren't barriers to access."

I've written before about how the shortage of primary-care doctors makes the health reform effort moot. Now imagine the dis-incentive to become a general practitioner when the government decides to pay you well below the prevailing rate, as Medicare does today.

With the public option on life-support, it looks more likely that Obama will adopt a Massachusetts-style health insurance mandate. Charles Krauthammer explains what this means for the whole country:

There will be only one way to make this work: Impose an individual mandate. Force the 18 million Americans between 18 and 34 who (often quite rationally) forgo health insurance to buy it. This will create a huge new pool of customers who rarely get sick but will be paying premiums every month. And those premiums will subsidize nirvana health insurance for older folks.

Well, it's about time we did something for older Americans.