Dear critic, Do you or don’t you

support the Massachusetts Health Care Reform?

We get the question all the time, especially from other think tanks and national press outlets trying to figure out what this all means as the presidential election starts to show signs of life. (When presumed frontrunners of each party start hammering on each other, you know the line-up is soon to winnow down.)

At the end of the day, Pioneer supports whatever will lead to better health care outcomes and contain the rising cost of care. It’s an empirical question, or to put it more colloquially, the proof is in the pudding. And anyone who’s been an in-patient knows it’s hard to be patient with what passes for dessert in the hospital. (Do you think the quality of care can be correlated to the quality of the food?)

Increasingly, I am concerned about the “mandate.” Especially as 2008 approaches, whereafter the moratorium on mandates is lifted.

Look, mandates means you have to define what it is you’re mandating–the so-called minimum benefits package. Over time, because of political pressure and the fact that there is only a diffuse constituency to play opposition to new mandates (taxpayers), that minimum package will grow and the mandates will become a huge cost-driver. From my conversations with advocates, this could happen fast.

Just imagine the lobbyists lining up to ensure that obesity pharmaceuticals, lasik surgery and hair transplants are among the mandates. Folks, I’m kidding (kind of), but you get the picture, and it’s not a pretty one.

I can see the next gubernatorial debates coming to a head when a major party candidate known for his bare pate removes his toupee to show, yes, a mane every bit as full as Gene Shalit’s.

“Together we can have a bad hair day!” will be the mantra suffused with empathy for others. Uh, no thank you.