health care a relatively small cost to the state. Nonetheless, the state's fiscal crisis, combined with a new and very different ideology about the role and value of government contributed to its almost certain demise.
Partnerships between public and private sector leaders can yield valuable insights and solutions to social problems. For the first time in Massachusetts' history, the state actively sought the involvement of the small-business community in solving a very real social problem. Opposition to the mandates contained in the law at once obscured and made possible an alliance between the state and small business that aimed to unravel the health insurance morass that threatened them. As the largest consumers of health care in this country, government and business came together to address the problems of cost and access to health care.
Gradually, the state and small employers began to learn the business of insurance. It allowed them to navigate successfully a package of insurance reforms through the powerful vested interests of the insurance community, and it fostered the phase-in initiatives, which if allowed to continue, would have taught us important lessons about how costly universal access really is. Taken together, they would have taught us whether the exclusion of 35 to 38 million people nationally from our health care system, many on the grounds that they are too sick, too old, or happen to be in the wrong job to merit coverage, is a policy we, as a nation, can justify. Nonetheless, as this nation is forced to grapple with the worsening plight of a growing number of working and sick Americans who are left with no means of paying for their care, the Massachusetts story hopefully will provide insight into the benefits of constructing a solution to this problem.