EDITORIAL : THE NEW YORK TIMES, USA

Health Reform in Massachusetts

Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.

Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.

There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.

Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.

The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.

Who Should Run the I.M.F.?

The arrest of Dominique Strauss-Kahn has turned the International Monetary Fund into front-page news and cast a harsh light on its dysfunctional workplace culture. Whoever is chosen to succeed Mr. Strauss-Kahn must be prepared to address both the European debt crisis and the institution’s own problems.

For 65 years, all of the fund’s managing directors have been chosen from the wealthy industrialized countries of Europe. That tradition, along with the United States choosing the president of the World Bank, may have fairly reflected the economic geography of 1946. But it does not reflect today’s world, and powerful new players like China, India and Brazil rightly resent it.

Both jobs ought to be filled on merit alone, with a strong emphasis on technical and diplomatic competence and managerial skills. That should not exclude qualified Europeans, but neither should it guarantee them the job.

European governments are already lobbying for Christine Lagarde, who is now the French finance minister, a job Mr. Strauss-Kahn also held. The I.M.F. has been led by French managing directors for 36 of its 65 years. That is too clubby for an institution whose main business has been to persuade foundering governments to undertake unpopular economic reforms in exchange for loans.

Even before the Strauss-Kahn scandal, the fund had a reputation among many of its female staff members as a workplace that failed to police unwanted amorous advances and other forms of harassment. The next managing director will have to make zero tolerance the rule.

Ms. Lagarde, who would be the first woman to hold the job, has the experience and many other strong qualities. But there are other talented candidates to consider, including Tharman Shanmugaratnam, Singapore’s finance minister and chairman of the I.M.F.’s financial committee, and Arminio Fraga Neto, a former head of Brazil’s central bank and an architect of that nation’s successful economic reforms. Voting on the governing board is weighted by historic economic heft. So if the European Union lines up behind Ms. Lagarde, no single developing-world alternative emerges and Washington backs Europe’s choice, there may be no real contest. It would be better for the I.M.F., and for the winner, if there was.

Haiti’s President Martelly

The peaceful inauguration this month of Haiti’s new president, Michel Martelly, should give Haitians cause for pride and cautious hope that their country can move beyond mere survival and start rebuilding.

Mr. Martelly, a former pop star, ran a serious campaign. When he put on the presidential sash on the grounds of the still ruined presidential palace, he vowed to remake his country: promising to provide free education, and battle crime and corruption, and end the humiliation of being the hemisphere’s charity case.

There is, of course, a very long way to go. Well over half-a-million Haitians are still without homes, many living in camps where disease and violence are unchecked. Mountains of rubble remain. The cholera epidemic continues and will only spike as the rains get worse. Great projects, like a textile factory in a giant industrial park, have not moved much beyond press releases.

The untested Mr. Martelly will have to show adroitness, not bluster. He will need to work with a Parliament dominated by members of former President René Préval’s Unity Party. And rally international donors whose patience has flagged and attention has shifted elsewhere. He will need to deliver tangible improvements, not just promises, to his people.

Mr. Martelly will need to do what Mr. Préval refused to: make difficult decisions, even if they displease entrenched elites or cronies. One reason so few houses have been built is Mr. Préval’s refusal to use the power of the presidency to resolve disputes over land ownership.

The new president will need to push Parliament to streamline regulations that stymie business development and jobs, and overhaul the failing criminal justice and judiciary systems. He will have to push Haiti’s partners to hire and train Haitians, to build the capacity of government ministries and civil society.

The United Nations, the United States and other international donors will need to work closely with Mr. Martelly. Too much time has already been wasted.

Gas Prices and Political Pandering

The closer one looks at what passes for serious debate in Washington over energy, the more depressing it gets. The Republicans have nothing to offer but drill, baby, drill. The Democrats are rightly trying to end industry’s cushy tax breaks, but that’s not an energy strategy.

And everyone, including President Obama, seems more interested in scoring political points over rising gas prices than in confronting complex matters like energy security and climate change.

In the Senate, the two parties spent this week beating each other up without advancing the discussion. The Republicans and three oil-state Democrats blocked a worthy Democratic attempt to strip the five biggest oil companies of $2 billion in tax breaks they do not need. The Democrats then crushed an effort by Mitch McConnell, the Republican leader, to match two outrageous measures passed by the House that would expedite lease sales in protected coastal waters while undermining safety reforms adopted after the oil spill in the Gulf of Mexico.

Mr. McConnell said his bill would bring relief at the pump by raising domestic output. That is fiction. Production will take years to come online and even then would have a tiny impact on prices set on the world market.

Mr. Obama has made the right arguments in the past — that the way to achieve true energy security and protect the environment is with greater automobile efficiency, alternative fuels and mass transit. Last weekend, he, too, was out there pitching domestic production.

He announced several modest steps to speed up the search for oil and gas, including seismic studies to measure resources off the Atlantic Coast, long-planned lease sales in the gulf and further development of the National Petroleum Reserve in Alaska. None will quickly lead to new drilling or have any effect on gas prices. Yet because his remarks were framed as a response to gas prices, he helped feed the Republicans’ bogus narrative.