Amidst all the hoopla about the health insurance program just passed in Massachusetts, it's worth recalling that policy makers in the state have gone down this road before--and failed to reach their destination. Former Governor Michael Dukakis still sounds bitter about the way his successor refused to implement his program. "If Bill Weld hadn't screwed it up, we'd have universal coverage in Massachusetts," he says.
Weld wasn't the only one who was skeptical about Dukakis' 1988 package, which demanded that employers provide health insurance--or make big payments to the state. As the state's prosperity of the 1980s gave way to recession at the end of the decade, state legislators, who had been far from unanimous in support of the idea anyway, suspended the program time and again. Finally, in 1996, it was repealed altogether.
"It's widely viewed that it crashed and burned and was a failure," says John McDonough, a former legislator who now runs Health Care for All, an advocacy group. But as McDonough and others point out, that's a misreading. The 1988 law was not entirely a failure. Several of its provisions managed to stay on the books. It offered health insurance to the unemployed and allowed the disabled to work without losing Medicaid coverage. The law also created the nation's first student mandate, requiring college students to have or buy health insurance before they could enroll. Those changes remain in effect.
Even the repeal of the law in 1996 was more complicated than is usually realized. Legislators agreed to kill the old Dukakis promise of universal coverage as part of a deal in which the business community agreed to back an expansion of children's health coverage. That support, in turn, created a majority for the children's programs big enough to override Weld's veto. All told, nearly half a million more Massachusetts residents receive coverage under Medicaid than was the case a decade ago, even before the new law takes effect.
History may repeat itself: Given the amount of money that universal coverage will eventually cost, Massachusetts could fall short again despite all the current promises. But the saga of the 1988 law is a useful reminder that health care reform is a long-running political soap opera. The successes and failures aren't so easy to tell apart.