The Price of Compromise: The Massachusetts Health Care Reform‪.‬

To the Editor: Six months into its implementation, four key aspects of Chapter 58, the Massachusetts health care reform recently discussed in the Hastings Center Report (September-October 2006), are clear. First, the Uncompensated Care Pool--a unique, progressive Massachusetts financing mechanism to pay safety net providers directly to care for the uninsured--has been diverted to the private insurance industry. Second, the most costly and dysfunctional feature of our current health care financing--namely, linking health care resources to employment and thereby channeling vast resources through the private insurance industry--has been explicitly reinforced as a social good. Third, the excess cost for obtaining commercial insurance for the poor will be shifted, in theory, to those individuals themselves. And finally, the public debate on cost has overemphasized insurance premiums, rather than what services they will buy in the "affordable products" required under the individual mandate. The regulatory mandates on the insurance industry are inadequate to assure our low-income population's continuity of and access to care.