Can Mass. health plan go national?
NOW THAT the Massachusetts Legislature has passed a law requiring health insurance, is this possible for the United States? It is worth asking, because innovative state action was the harbinger for America's most successful social reform -- Social Security, which passed in 1935 and covered almost all workers by 1950. Proponents of insuring the 45 million Americans that remain uncovered can learn lessons from that earlier struggle.
It never happens that contentious reforms, once an innovator or two take the plunge, are simply seen as such good ideas that state after state will gladly adopt them. New York and California, as well as Massachusetts, passed innovative old-age programs in the early 1930s that compelled counties to participate, but many Southern and Midwestern states continued to drag their heels. If there is going to be health coverage for all Americans, the federal government will have to get involved.
But state-level action does matter in providing models and leaders. Franklin Roosevelt was governor when New York's landmark old-age legislation was passed, and he was committed to the issue when he was elected president in 1932. Representatives from California and Massachusetts provided congressional leadership to steer old-age proposals to passage.
Social Security also provided language that shielded politicians from an American public that can become hostile to government, even when public opinion is in favor of action. The makers of Social Security called the payroll taxes for the program ''contributions," making them seem like private insurance policies, and levied them on employers and employees alike, claiming that burdens were being shared. Roosevelt railed against the ''dole," which represented in the public mind the European approach to social policy.
The Massachusetts legislation provides similar political cover. By requiring individuals who can afford health insurance to buy it, the proposal emphasizes individual responsibility. By placing fees on businesses that fail to cover their workers, the proposal sanctions those not carrying their weight. A Massachusetts proposal writ large can be favorably contrasted to the highly complicated and much maligned Clinton health security plan of the 1990s.
It is also key, however, for mass-based political organizations to demand a more radical approach. Social Security would never have never gotten off the ground without the demands of the Townsend Plan, which organized 2 million older Americans into Townsend clubs that demanded far more generous treatment to retirees than Roosevelt and Congress offered. The Townsend Plan and other pension organizations also had supporters in Congress calling for universal, government-provided pensions.
Their analogues today include advocacy groups such as Health Care for All and others, like Senator Edward Kennedy, supporting the extension of the single-payer Medicare program down to younger Americans. As in Massachusetts, for America to solve the problem of health coverage religious organizations will have to press for an alternative, and, so, too, will labor unions and other groups with membership and clout like the AARP.
Unfortunately for Mitt Romney, the Massachusetts governor who hopes to ride the issue to the White House, if healthcare is going to run according to the Social Security playbook, he cannot lead the way. The governor is threatening to veto an uncontroversial $295 per employee fee on businesses who deny coverage to prove his antitax credentials to Grover Norquist and the Republican right.
But such a substantial governmental commitment will take some revenues, whether one calls them fees, premiums, or contributions, and can happen only if the Democrats return to power. Social Security was hashed out over 15 years during which only Democrats Roosevelt and Harry Truman occupied the White House, while former president Herbert Hoover and candidate Alf Landon were taking potshots from the outside. Too many Republicans today are tied to regressive tax-cut policies in the way that Hoover and his congressional supporters were.
That earlier Democratic run took more than a little luck. Though not entirely the fault of Hoover, the Great Depression discredited the Republican Party as whole, including its tax cuts and backward approach to social policy. Possibly the highly unpopular war in Iraq, the mishandling of Katrina, and the bribery and illegal fund-raising scandals will engulf the Republicans in a similar way.
It happened before. It could happen again.
Edwin Amenta, professor of sociology at University of California, Irvine, and New York University, is author of the forthcoming ''When Movements Matter: The Townsend Plan and the Rise of Social Security." 
