An unpleasant diagnosis
THE STATE'S BUSINESS COMMUNITY is one of our biggest assets. But some of its leaders don't seem to understand that the state's healthcare system is anti-busineess. Maybe they just don't understand how the healthcare system works. If they did, they would be supporting Speaker Sal DiMasi's proposal for healthcare reform, just like the business leaders who worked with me on universal health insurance in 1988.
Why is the current system such a burden on Massachusetts businesses? First, because it is expensive. Second, it forces employers who do insure their employees to pay for employers who don't.
Let's assume, for example, that you are one of thousands of small businesses in Massachusetts providing insurance for your employees and their families. You are paying high premiums, which have been going up in double digits for the past five years. When an employee of an employer who does not provide health insurance ends up in the emergency room, that cost is passed on to you in the form of a premium tax and hidden surcharges that the hospitals include in their rates.
In short, a small business in this state is not only paying for its own employees, it is also paying for the employees of
And it isn't just the state's businesses that are getting it in the neck. Taxpayers are also, because they are paying hundreds of millions of dollars under the Medicaid program to insure the families of working people whose employers don't cover them.
Medicaid is now the biggest item in the state's budget. It exceeds $7 billion. Clearly, the Commonwealth cannot continue to be the state's insurer of last resort. We have other responsibilities that we aren't meeting. Our infrastructure is falling apart. We have a housing crisis. Property taxes continue to rise because the state can't seem to provide its cities and towns with their fair share of revenue growth.
Recently, some representatives of the business community have said that the real answer to the healthcare problem is what they call an ''individual" mandate. Under this proposal, everybody in the state would be required by law to insure him or herself and their families. Presumably, it would be a criminal offense not to do so. The Commonwealth, its proponents say, would then subsidize the cost of health insurance on some kind of sliding scale, based on need.
The problems with any such plan should be obvious. Why would any rational business continue to insure its employees and their families if the Commonwealth stood ready to take that responsibility off its hands by subsidizing individual coverage? In short, any such plan would inevitably result in massive disinsurance by employers who currently insure-- and a state budget that would make the current Medicaid budget look like child's play.
All this doesn't mean that the DiMasi bill will work. His proposal to require all employers with 10 or more full-time employees to offer insurance is a tight mandate. It may be better to raise it to 20 or more, which would still insure at least half of the uninsured people in the state as well as save a half a billion dollars in current Medicaid spending that could then be devoted to coverage for the remaining uninsured.
There may be other adjustments that can make the bill both better and fairer to all. But the business community has to get serious about a long-term plan that stops putting the burden on small- and medium-sized businesses while some of the biggest employers in the state get off scot-free.
Former Massachusetts Governor Michael S. Dukakis teaches at Northeastern University. 
