One of the most ambitious healthcare initiatives by a US state is
entering a make-or-break implementation phase - just in time to
become a model of success or failure for presidential candidates.
Starting next week, on July 1, most residents of Massachusetts
will be required to carry health insurance, even if their employer
doesn't provide it and even if they aren't eligible for a government-
Already the Massachusetts experiment offers at least two lessons:
First, a major healthcare overhaul is possible, despite all the
competing interest groups. Second, a big change doesn't mean a quick
fix. The state has already scaled back its early hopes that all
residents would be covered.
The implementation here comes as pressure mounts on politicians
nationwide to restrain rising medical bills and extend health
insurance to the roughly 15 percent of Americans who lack it. Polls
suggest that most Americans view the current healthcare system as
broken. Federal and state budgets are strained by medical inflation.
Increasingly, businesses also see a crisis - one that affects their
ability to compete in world markets.
For the nation, the tough choice ahead is to define the solution.
Does it involve putting more responsibility with government, with
individuals, with employers, or some blend of these? What's being
tested in Massachusetts is a hybrid approach, but one that puts
substantial obligations and choices with individuals.
The Bay State plan has skeptics and detractors on both left and
right. Supporters say that fact hints at the plan's balance - and at
why it might succeed.
The plan represents a compromise of ideas proposed by Republican
Gov. Mitt Romney, now out of office and running for president, and
"It's coming right down the middle," says Jonathan Gruber, a
professor at the Massachusetts Institute of Technology who helped
shape the Massachusetts plan. "It's sort of an American approach to
Canada and many European nations cover all their citizens through
systems in which the government alone pays for healthcare. Whatever
path America takes, a central challenge is how to balance the goals
of coverage and cost control. Americans can only be covered if they
can pay for it, whether that payment is individual or collective.
The Massachusetts plan outlines a base level of required coverage
and encourages competition among insurance providers. A new state-
created marketplace, called the Commonwealth Connector, provides the
forum for individuals and families to compare health plans online
just as they would airline tickets. Gold, silver, and bronze labels
give clues about the scope of coverage. The prices also vary by age
and occupation. One "bronze" plan, for example, would cost $370 a
month for a 50-year-old Bostonian who works in retailing.
"This plan will insure the uninsured. That's very laudable," says
Regina Herzlinger of Harvard University in Cambridge, Mass. But
she'd like to see consumers empowered with more insurance products
in the "supermarket," and more information about their
"I now know more about that raisin bran than I do about the guy
who's going to do [an operation]," says Ms. …