The Time Will Come When 'Social Cohesion' Gets Into the Universal Health Care Equation

"A trend will continue until it cannot."

I wish I'd come up with that but I did not. It's an adage that's been around for years, heard most frequently in the context of economics.

"A trend will continue until it cannot."

It sounds like something uttered by a Zen monk, but that's not why I like it.

Its true appeal, and its descriptive utility, comes, I believe, from its implied message of finality and woe.

It's kind of like a doctor telling an alcoholic, "Don't worry, that stuff won't kill you until it does."

Thoughts of "uncontinuable" trends were rampant this week in Boston as the Division of Health Care Finance and Policy conducted hearings on how Massachusetts can contain the ever-rising cost of health care and thereby preserve its first-in-the-nation system of universal health coverage, now five years old.

According to testimony given the other day by Massachusetts Secretary of Administration and Finance Jay Gonzalez, health care spending will consume half of the entire state budget by 2020 if current trends continue. Half!

That prediction made me think of how Paul Krugman, a Nobel Prize-winning economist and New York Times columnist, describes the U.S. government: "A giant insurance company that also has an army."

If Secretary Gonzalez's prediction comes true, Massachusetts in 2020 will be a giant insurance company that also has state troopers.

Health care costs that keep growing at five times the inflation rate literally eat other government programs alive.

Looking at the recession-fueled jump in the number of residents enrolled in Medicaid, the State House News Service observed, "The trends point toward an entitlement program with runaway costs that's devouring new state revenues and leaving other services in areas like public safety, human services, education and local aid subject to continuing budget cuts amid a sluggish economic recovery and dried-up federal revenue sources." (That was from a 12/13/10 article headlined, "Medicaid Costs Surge Past $10 Billion, Devouring Uptick in Tax Receipts.")

Massachusetts today finds itself in a health care financing crisis. Thus, we can expect our state government to make changes it would not even consider in gentler times, and to move in directions it would rather not go. That's what crises force you to do.

So what kind of changes might Massachusetts be compelled to make?

I'm no seer, but I can see the day when everyone on Medicaid has to obtain primary care at state-run clinics staffed by nurse practitioners, and when most members of the middle class are restricted to lower-cost care providers and networks, and are discouraged from seeking advanced diagnostic testing by financial penalties and disincentives.

In other words, it could be a bare bones health care future for most of us.

Of course, that would lead to serious problems in our society. The poor and the working class would see the affluent getting better care, and more health care services, and they would burn with resentment. They'd look upon government as the enemy of their children and grandchildren. Social divisions would widen. Class resentments would spread like viruses to places they hadn't been seen since the Great Depression.

At that point, the Governor of Massachusetts would have no choice but to step forward and promise to fix this horrible mess. He or she would vow to create a new system based on equal access to state-of-the-art health care. No slack would be given to any vested interest in our huge insurance-medical-hospital complex.

The Governor would emphasize the extreme difficulty of this noble task and ask for universal sacrifices -- everyone giving something up or paying some price -- to correct and resurrect the Massachusetts system of universal care.

And the Governor would base this historic struggle on the social cohesion that would result from an equitable system of universal care, which is what President Obama should have done when reforming health care in 2009.