The passage of a universal health initiative in Massachusetts is big news. Of course, it was also big news when a certain Michael Dukakis rode that headline to the Democratic nomination in 1988. This week a Republican governor with strong social conservative credentials, albeit one from liberal state, is hoping that the same headline will propel him to his party's nomination 20 years later. Naysayers on the left and the right point out that there are plenty of holes in Romney's plan. It depends on federal dollars to fund Medicaid expansion. It demands that individuals buy affordable insurance while it may just be cheaper for them to pay the $1,000 fine. The same problem is doubly true for employers not offering insurance who only have to pay the equivalent of one month's regular insurance premium--an assessment not a tax, you understand. And, of course, it does nothing to rein in the underlying increases in care costs, which are as high in Massachusetts as anywhere.
But the politics and the symbolism of this news are well worth watching. Most observers of the healthcare system are agreed that we are in a crisis and things are getting worse. Costs are going up, insurance is becoming less affordable, employers are dropping coverage and the population is getting older one year at a time. At some point we have to have the big conversation that hasn't happened since 1993-1994. If a leading Republican feels that he needs to support universal health insurance--a traditionally Democratic issue--then we may just be seeing the ground symbolically prepared for the coming debate. On the other hand, we might just remember what happened to Dukakis and his universal health insurance legislation. - Matthew