How did you become so involved in health care reform? For the first part of my career, I focused on basic science, helping advance our understanding of how health insurance impacts the behavior of firms and individuals. Then, from 1997 to 1998, I went to the Treasury to work as the assistant deputy secretary for economic policy. I realized that academics don't do well enough at translating our somewhat esoteric studies into what policy makers really want to know, which is how their proposed legislation will impact the nation. So after returning to academia, I developed a "micro-simulation" model that translated the important lessons that I and others had learned about how health insurance impacts the economy into direct estimates of how legislation affects things like the number of people covered with insurance and the costs to the government.
How did you use this model to assist in health care reform in Massachusetts?
Gov. [Mitt] Romney asked me to help him ensure that his health care reform would meet his goals of covering the uninsured in Massachusetts while fitting into the budgeted spending level. In particular, I showed him that the individual mandate allowed him to cover the citizens of Massachusetts cost effectively. I then worked with the legislature to design the health care reform and was appointed to the Connector Board that implemented the law.
What role did you play at the national level?
I was initially brought on by the Obama administration as a technical consultant to help them figure out their general position on health care reform. I worked closely with the Congress to model the various options that they were considering to meet the overall goals laid out by the president. There were dozens of decisions that needed to be made and I was able to help with both my model and my experience in Massachusetts.
Is "Obamacare" the same as "Romneycare"?
The core of the national reform builds on the same "three-legged stool" approach set up in Massachusetts: insurance market reforms so that insurers can no longer discriminate against the sick, an individual mandate so that the healthy can no longer "free ride" on the system and so that insurers can price insurance fairly, and subsidies to make insurance affordable under that mandate. This has worked really well in Massachusetts, where we have covered two-thirds of the uninsured within our planned budget, and I anticipate it will work as well at the national level. But the federal reform is also more ambitious, in particular trying to take on the important issue of cost control.
Now that the reform is passed, what are you doing?
After the bill passed, my son said to me: "Jeez, dad. This is the most important thing you'll ever do." I thought he was probably right, and that was kind of depressing [laughs]. I spend a lot of my time explaining the health care reform. It's not that people don't like health care; they just don't understand it. I've been writing editorials and articles, and right now I'm actually working on this graphic novel explaining the health care reform to come out next January: Health Care Reform: What It Is, Why It's Necessary, How It Works. I continue being on a board that oversees implementation in Massachusetts, and will help our state transition to the national system. I am also helping a number of other states with their implementation issues. And I am returning to my role as a basic scientist to try to answer two of the key questions we still face as reform moves ahead: How should we set up exchanges to help individuals make the most effective choice of health insurance plans? And how can we redesign reimbursement of providers in order to ultimately slow the growth of health care costs? I hope that someday this kind of basic research can once again be translated into language that can help with future health reforms.