Here’s my editorial in today’s FierceHealthcare:

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 blue state, is hoping
that the same headline will propel him to his party’s nomination twenty 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 health care 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, albeit only one year at a time. At some point we have to have the big
conversation that hasn’t happened since 1993-4. 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.