Guinea pigs

The future of the nation’s health-care reform rests on the tattooed shoulders of Massachusetts’s young adults
By DAVID S. BERNSTEIN  |  October 31, 2007

071102_bike_main
Insure this!: Why some twentysomethings won’t buy health insurance — even though it means they’ll be breaking the law. By Mike Miliard

Hey, Boston hipster. You live in Allston-Brighton, you drink Pabst Blue Ribbon, and you’re political to the extent that you sometimes wear a “Don’t Tase me, bro” T-shirt.

But the future of national health-care reform is playing out in Massachusetts, and the key players who will determine whether we have found the model for success are people like you: first-jobbers, slackers, and new-economy entrepreneurs, folks who seldom contemplate their role in shaping public policy, and who are usually ignored by those in charge.

Massachusetts is, of course, requiring every adult citizen to purchase health insurance by the end of 2007. This experiment is taking its bow as the idea of reforming the national health-care system has climbed in status to the top of the issue ladder. States across the nation are drafting their own plans, and presidential candidates are touting their solutions. Many of the ideas — including Governor Arnold Schwarzenegger’s in California, and Senator Hillary Clinton’s on the presidential-campaign trail — closely ape the innovative solution being imposed here, which was developed by, of all people, Mitt Romney. (He’s since issued confusing platform directives on his stance, but more on that later.)

Democrats and Republicans alike are now talking about moving forward with some kind of national reform. The Bay State experiment has “been an inspiration to the national debate,” says Judy Feder, dean of the non-partisan Public Policy Institute at Georgetown University. “Massachusetts going forward gave [health-care reform] a big boost.”

And the stakes are clear: if the system works well in Massachusetts, odds are that the nation will follow. If it fails here, this approach dies.

Popular mandate?
Massachusetts is the first place in the US — and only the third in the world — to mandate that every individual buy health insurance. That coverage mandate is key to the plan’s goal of spreading the risk and costs among all citizens. Already, presidential candidates Clinton and John Edwards have included the individual mandate in their own health-care proposals. California’s plan includes a mandate, too.

But national observers are far from convinced that the mandate is a practical solution. “Both John Edwards and Hillary Clinton are embracing a robust individual mandate, before it has been shown to actually work here,” says John McDonough, executive director of advocacy group Health Care For All, which fought for universal coverage in the state. “It is by no means settled that this will work in Massachusetts, let alone anywhere else.”

Some suggest that, while lower-income families will take advantage of newly available lower-cost insurance options, others will be harder to rope in. Namely, healthy, single, 25- to 35-year-olds, most of whom earn too much to qualify for subsidized rates, but little enough that health-insurance premiums — on top of rent, car insurance, and student loans — seem like an unaffordable luxury.

That cohort is the toughest group to bring into the insurance system, says Laura Trueman, executive director of the advocacy group Coalition for Affordable Health Coverage, in Washington, DC, whose members include physicians, insurance carriers, and consumer groups. “Many of them look at it and say, ‘The value for me is not there.’ ”

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