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Massachusetts miracle?

April 10, 2006

WITH ONE POSSIBLE EXCEPTION, no state has spawned more innovative ideas than Massachusetts. The latest came last week when its legislature passed a bill that could, if it delivers on its promise, make Massachusetts the first state with universal healthcare.

This could be as revolutionary as when the Minutemen squared off against the British at Lexington in 1775. One state, Hawaii, requires all employees who work more than 20 hours a week to get health insurance, but that requirement still leaves one in 10 people without coverage. A handful of other states, including California, have discussed other ideas to cover more of the uninsured.

The Massachusetts proposal takes a novel approach. Just as most states force drivers to carry auto insurance, under the plan, all Massachusetts adults would have to carry health insurance. If they don't, they would have to pay a penalty. The state plans to subsidize insurance for people earning below three times the federal poverty level and to pay for that with a combination of money it gets from the current system and fees it would levy on employers that don't offer health coverage.

The plan is ambitious and inventive. But there could be problems. For one, the state is betting that it will not cost much more than the present system. The current estimate is that the plan will cost the state $125 million more annually, and Gov. Mitt Romney, who is eyeing a 2008 presidential run, promises he won't have to raise taxes. But that promise assumes that the federal government will continue to contribute $385 million a year to Medicaid, employers will pay $295 a year for each worker they don't cover and basic health insurance will remain affordable.

And the proposal is not necessarily designed to address the biggest elephant in the operating room: healthcare costs. Even if Massachusetts could cover all of its residents tomorrow, if it does nothing to cut the cost of the care that doctors and hospitals provide, it will either have to plow obscene amounts of money into the system to keep universal coverage going or eventually abandon it.

Part of what Massachusetts' experiment shows is that there are no easy solutions to the U.S. healthcare crisis. Solving it will require a more sober discussion at the state and federal levels.

Still, Massachusetts was true to its heritage last week. Maybe its actions will generate that national discussion. State leaders also showed how a Democrat-run legislature can get along with an often stubborn Republican governor to come up with big ideas to deal with big problems. Now, where else might that come in handy?

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