With 45 million uninsured Americans and the rest of us paying far more for health care than any other first world country, universal coverage would seem to be a no brainer. But as Hillary Rodham Clinton found out when she tried to ram a national universal coverage plan through Congress in 1993, what makes sense and what passes muster in Washington are two very different things.
There are three reasons why universal coverage has been dead on arrival:
* Health insurance companies, which stand to make less money.And so it was pleasantly shocking this week when the Massachusetts state legislature thumbed its nose at the conventional wisdom and created near-universal health care coverage.
* Pharmaceutical companies, which stand to make less money.
* Congressfolk, who are addicted to the money they get from health insurance and pharmaceutical companies.
What accounts for this lightning strike?
First and foremost, Democrats and Republicans alike checked their egos and heeded a calls by Republican Gov. Mitt Romney and Democratic U.S. Sen. Teddy Kennedy to do the deed.
There were other factors as well.
The feds threatened to cut $385 million in aid if the number of uninsured state residents was not reduced, while a coalition of advocates, including religious leaders, had gathered enough signatures to approve a ballot measure more liberal than the bill passed by the legislature that was likely to be approved by voters.
Under the plan, all Massachusetts residents will be required to take responsibility for their own health insurance and all companies with 11 or more employees will be required to help pay for health insurance. Low-income residents, of which some 200,000 are currently uninsured, will be eligible for substantial state subsidies.
The plan takes a carrrot-and-stick approach. Insurance will become easier and cheaper to purchase, but beginning in 2008, uninsured residents will have to pay a hefty penalty if they fail to fall into line.
The Massachusetts plan is a work in progress. It undoubtedly has flaws. But it is a start. Lightning has indeed struck in Massachusetts. Can it happen elsewhere?
Let's hope so.