Why Massachusetts Worked (relatively) Well

After reading through the transcript of a Kaiser panel on the Massachusetts reform, it bears repeating that Massachusetts had several things going for it that made

• In the 1990s, the state had enacted tax increases to compensate providers for charity care. Thus there was already a substantial pot of money that could be redirected.
• Prior to reform, the state had a fairly low level of uninsured (10% versus about 15% nationwide)
• The state is relatively prosperous.
• The state has a strong culture of civic responsibility, which lessened business community opposition to reform, and robust civic culture, which means there were lots of people who could help with community outreach into areas with a large number of uninsured.

None of these things are true nationwide. And the fact that none of them are true will make it harder to get a reform bill that is (a) truly affordable, and (b) popular. And of course (a) feeds into (b)—the Kaiser panelists were very clear that they wanted people to feel like the insurance they were now mandated to purchase actually covered something. At the moment, the current bills are really failing on all fronts. It's going to take heroic increases in revenue or cuts in spending to get to where we need to be.