Universal Health Care: The Diagnosis

Massachusetts put into practice the health care solution everyone is arguing about. Here's how it works and what it means for the rest of us.

By Mark Gimein

From Reader's Digest

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Photographed by Jason Grow

Stephen Gore was battling kidney cancer when he signed up for the plan.

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Photographed by Jason Grow

Stephen Gore was battling kidney cancer when he signed up for the plan.

The worst of it, Stephen Gore thought, had passed. There was the kidney cancer, and then there was the operation to remove it, and finally, after a year and a half, it looked like it might actually be over. Not over over, because you never know with cancer, but over for the moment, over for this year, over except for the ever-present thought that it could return. He'd gone to see the doctor and get the PET scan. If it showed no hot spots, it would be the last one for a while. He could count himself as cancer free.

It was a Friday. Right after the PET scan, he drove from the Manet Community Health Center in Hull, Massachusetts, back to his job on a computer help desk, and as soon as he got back, he got called into a meeting. Last day-pack up your stuff, please. And by the way, your company health insurance ends tomorrow.

Gore went home and started looking for a new job. The PET scan results came in on Tuesday: no hot spots, no cancer-for now. There'd still be appointments with the doctor in the years to come. But for now it looked okay.

Gore knew that Massachusetts had passed a statewide health care plan, and maybe he'd be eligible, but it felt like a handout and he didn't think of himself as the kind of person who took government handouts. He could continue on his employer's health plan for 18 months, at $1,175 a month for him and his wife, Robin Flint.

Of course, he didn't have a job, and Robin's part-time piano-tuning business wouldn't come close to bringing in enough. The $1,175 seemed completely out of reach; it may as well have been a million. Gore thought he'd make do without health insurance. It was only when he was sitting in the living room and the house was quiet and he heard Robin wheezing from the next room that Gore realized she was skipping her asthma medication to save $175 a month. He went right back to the Manet Community Health Center and signed up for Massachusetts's new subsidized health insurance program, Commonwealth Care.

There's a very good chance that you can imagine yourself in Stephen Gore's shoes. Sixty percent of Americans have health insurance tied to their jobs (or their spouses' jobs). The system of employer-provided health insurance that started with the Big Three automakers in the 1940s and 1950s is showing bigger cracks every year. Employers are less likely to offer insurance than they were in the past, and virtually all are asking their workers to pay more for the coverage they do offer. A survey by the nonprofit Kaiser Family Foundation in April showed that 28 percent of Americans, more than one in four, had serious trouble paying for their family's health care needs. Close to 50 million Americans have no health insurance at all. That's why health care is a centerpiece of the 2008 presidential election. Both nominees, Senator John McCain and Senator Barack Obama, have presented far-reaching health care reform plans. (For details, go to readersdigest.com /2009health.)

Meanwhile, one place stands out in the national health care debate: Massachusetts is the only state that has embarked on an ambitious plan to make sure all its citizens have health insurance. It's not a new idea. California governor Arnold Schwarzenegger proposed a state plan in 2007, Bill Clinton proposed a national plan in 1993, and Earl Warren and Harry Truman proposed plans for universal coverage as far back as 1945. Massachusetts, however, is the first of the 50 states to pass legislation that aims at universal coverage. The plan that passed in 2006 created Commonwealth Care, the program through which Stephen Gore got health coverage.

Commonwealth Care has made Massachusetts a test bed for some of the key ideas for a national health care fix-and a flash point for the debate about what we can afford to provide and who should pay for it. The Massachusetts experiment is a study in what can realistically be achieved by a universal health care plan, as well as the costs and trade-offs it takes to get there. For some of the state's uninsured, such as Gore, Commonwealth Care has been a godsend, but for others it imposes some pretty steep costs. In an election year in which both parties promise to reform health care, Massachusetts might point the way to a national model and also might hint at why achieving universal health coverage on a national level could be a tall order.

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