Healthcare justice

IN MASSACHUSETTS, most people believe that everybody in the state should have access to the fine healthcare available to people with health insurance. Yet upwards of 500,000 live precariously outside the insurance safety net. House Speaker Salvatore DiMasi's comprehensive legislation, unveiled yesterday, offers the opportunity to provide this essential service of modern life to almost every person in the state.

DiMasi's proposal builds on that offered by Governor Romney, who, like the speaker, wants every person in Massachusetts obligated under law to obtain health insurance. That's a sensible mandate as long as the state provides subsidies to those of limited means.

Like Romney, DiMasi would tap into the state's uncompensated care pool, which defrays the cost of hospital care for uninsured people when they are sick. He and the governor would put that money to better use for preventive care designed to keep people well.

DiMasi's plan also draws on a proposal by Senate President Robert Travaglini: that companies not providing insurance ought to contribute to the cost of care for workers who now access services through the uncompensated care pool.

The speaker goes beyond Travaglini's limited plan by calling for an assessment on every employer of more than 10 people who does not offer health insurance. This would amount to 3 percent of payroll (5 percent for larger companies), and the money would help offset the subsidies given to provide the insurance for low-income people.

Spokesmen for small businesses came out against the plan, but it is unreasonable to expect care for their workers to be subsidized out of the free care pool. Hospitals, insurers, and companies that do provide insurance are the source of money for that pool. It is a drag on all three. DiMasi's assessment, less expensive then full-scale insurance coverage, would at least compel insurance-averse employers to contribute to the shared cost.

In an interview yesterday, DiMasi said he expects the House to pass the bill by Thursday, exceptionally quick work. The Senate will slow things down. Senator Richard Moore of Uxbridge, cochairman of the joint Committee on Health Care Financing, has expressed several reservations. For one, he wonders whether the employer contribution should apply only to larger companies, those that employ 50 or more people.

This issue and others are sure to be aired extensively in the Senate, but it is important not to lose focus on the main objective. DiMasi has offered a plan that, with its combination of the individual mandate and employer contribution, would go far to achieve one of the goals of a just society: the provision of healthcare for all its people.