Massachusetts becomes Canada as reform debate nears climax

Since it now appears the Senate will go with mandating people buy coverage and using subsidized exchanges to cover gaps, Massachusetts has become the focus, because it instituted just such a plan in 2006.

With Senate negotiators fashioning a compromise health care bill most expect to be the model for what eventually passes, Massachusetts is replacing Canada as the center of debate.

Early this year Canada's provincial-run system was seen as either a model or something to be avoided at all costs, depending on where you stood.

Since it now appears the Senate will go with mandating people buy coverage and using subsidized exchanges to cover gaps, Massachusetts has become the focus, because it instituted just such a plan in 2006.

That plan, Commonwealth Care, remains popular with voters, but support has dropped over the issue of cost containment.

Supporters call the plan a success, with 97 percent of people now under some plan against a national average of 85 percent.

But critics on both the left and right now say Massachusetts got it wrong.

There are differences between what Massachusetts has and what the Senate is working on, but three years on the state is facing the prospect of cutting subsidies, cutting dental coverage, and cutting people from the rolls. And some people there are finding the coverage unaffordable.

The lesson from both sides seems clear. Changing the financing without changing the system's cost structure is just rearranging deck chairs on a sinking ship.

But the band plays on.