When Massachusetts passed its groundbreaking health care reform law the eyes of the nation turned to the Bay State. Massachusetts made headlines for taking on an issue near the top of every pollster's list of key concerns for American voters. But the second sentence of the newspaper stories that appeared around the country included the reminder that Massachusetts had made this effort in 1988 but turned back prior to implementation as the slim political consensus eroded in a weakening economy.
The first response to the new plan was “Massachusetts is unique.” You are, after all, a relatively high income state with a smaller-than-average share of the population uninsured. But when Governor Schwarzenegger announced his plan to cover all Californians, and Governor Rendell issued his proposal for Pennsylvania, leaders in state houses around the country started wondering if they could develop a plan that met their own state’s needs.
Almost no one I work with in any state believes the right approach to universal health insurance rests with states addressing this issue one state at a time. But no one wants to sit around waiting for the federal government since leadership from that level is sorely lacking.
There are people lined up around the country waiting for and wishing that Massachusetts will fail. The Massachusetts plan does not meet their ideological vision of the world and they will pounce on any setback or sign of trouble. But there are also millions of Americans hoping you will succeed. They are happy to see a state willing to take on this tough issue in a manner that breaks through the ideological barriers that have stood in the way of national progress.
The Massachusetts statute represents an astonishing compromise. But there are many more decisions to be made as the plan is implemented. A continued commitment to compromise will be needed if the plan is ultimately to succeed. The eyes of the nation are focused on you. For the sake of your own residents and for the example you can set around the country, retain that spirit of compromise as you move from enactment to implementation.
National Academy for State Health Policy
This program aired on March 3, 2007. The audio for this program is not available.