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In Massachusetts, test for a pioneering health plan

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Canada and many European nations cover all their citizens through systems in which the government alone pays for healthcare. Whatever path America takes, a central challenge is how to balance the goals of coverage and cost control. Americans can only be covered if they can pay for it, whether that payment is individual or collective.

The Massachusetts plan outlines a base level of required coverage and encourages competition among insurance providers. A new state-created marketplace, called the Commonwealth Connector, provides the forum for individuals and families to compare health plans online just as they would airline tickets. Gold, silver, and bronze labels give clues about the scope of coverage. The prices also vary by age and occupation. One "bronze" plan, for example, would cost $370 a month for a 50-year-old Bostonian who works in retailing.

"This plan will insure the uninsured. That's very laudable," says Regina Herzlinger of Harvard University in Cambridge, Mass. But she'd like to see consumers empowered with more insurance products in the "supermarket," and more information about their effectiveness.

"I now know more about that raisin bran than I do about the guy who's going to do [an operation]," says Ms. Herzlinger, the author of a new book on healthcare.

Another criticism is that the financial penalties – imposed next year on residents who don't buy coverage – are so small that many people won't buy.

Madeline Ortiz is currently trying to find employment that includes healthcare coverage, something she doesn't have now. She received a letter in the mail about the new state requirement, but says, "I haven't even bothered with it yet. I'm not sure what my options are."

So far, Massachusetts is the first and only state to introduce an "individual mandate" to buy insurance. But the idea may be gaining credence among other states and interest groups. The Coalition to Advance Healthcare Reform, a new advocacy group formed by large employers and health insurers, includes an individual mandate among its core proposals.

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