What Will The Government Have to Do to Make Health Care Reform Work?

I'm glad to see columnists and reporters who cover health care turn to the question of how reform, once it's passed by Congress and signed into law by President Obama, will actually be implemented by the federal government. None of the spate of stories and columns on the importance of the Massachusetts model or of a mandate to purchase insurance discuss the formation of a new agency or division to handle implementation and oversight. But at least they're asking the right questions about implementation. For example, Alec MacGillis at the Washington Post dives into the question of how an individual mandate might work (and how it has worked in Massachusetts' reformed health care system). He writes:

The record of mandates is mixed, according to research done by Sherry Glied, a Columbia University professor of health policy who has been nominated for a position in the administration. The rates of people buying car insurance, for example, vary among states and do not correlate directly with the size of penalties for going without insurance. Overall, she found, mandates work best when compliance is relatively easy and affordable, when penalties are "stiff but not excessive," and when enforcement is prompt and routine.

But he also describes a massive community organizing effort that enlisted a wide array of public, private, and non-profit entities, ranging from churches to supermarkets, to spread the word about the mandate to purchase insurance. Massachusetts is a small state. Organizing such an effort would be vastly more complicated, both logistically and politically, on a nation-wide scale. Giving whatever federal office is tasked with that responsibility the resources it will need to accomplish it will be critically important to the success of health care reform. Paul Krugman is optimistic about the potential success of national reform efforts. I'd be curious to see him grapple with the organizational issues at stake.