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But there is only one real-life model in this country for the kind of sweeping change being considered in Washington, and that is in Massachusetts, where a landmark law signed in April 2006 has achieved near-universal coverage. And in that state, leaders decided from the outset to decouple access and cost, and to deal first with covering the uninsured.
Predictably, rising costs now threaten the viability of the Massachusetts plan, leaving Gov. Deval Patrick and his Legislature to play catch-up. Mr. Patrick has warned he might try to regulate insurance premiums if insurers and hospitals do not demonstrate self-discipline. And lawmakers are awaiting recommendations from a state commission charged with reinventing the payment system so doctors and hospitals are rewarded for preventive care rather than the quantity of treatment they provide.
