So Massachusetts recently passed universal health care through its state legislature. This is quite interesting because a Republican (well, as Republican as you can be in Ted Kennedy's and John Kerry's home state) governor spear-headed the effort. Since he's taken quite a bit of flack for this from Republicans and conservatives outside the state, he's written a piece for the Wall Street Journal defending his position. It's an interesting read.
The basic plan is that if you don't qualify for Medicaid, you have to purchase some sort of health insurance. If you can't find a plan you can afford, the state has some high-deductible plans you can choose from. If you can't afford the state plan, they'll subsidize you for part to all of the expense on a need-based sliding scale. Oh and on top of that, hospitals and doctors offices now have an Internet portal available through the state that can determine if a patient is eligible for Medicaid and sign them up if they are eligible but not registered.
I have two fundamental problems with this method. One is that their old program has about $1 billion sitting in the bank at their disposal. If this plan were implemented somewhere where there wasn't a $1 billion cushion, there might a significant raise in taxes, especially at first. (There might still be one anyways if this doesn't pan out the way they think it will.) The second thing I see is that 20% of the uninsured residents of Massachusetts qualify for Medicaid but do not have it. If part of your cost reduction is giving the debt to the federal government by way of signing more people up for Medicaid, then you're not really saving money there at all. You're getting money from where it should be gotten from and that is a good thing, but somebody is still paying that. Going out there and saying that this new plan won't raise taxes is a bit disingenuous in light of this.
But in summary, the governor of Massachusetts claims he has a universal health care system in place in his state that won't raise taxes* or broaden government control of health care. Another goal of his was to have no employer mandate. A "$295 per-person fee charged to employers that do not contribute toward insurance premiums for any of their employees" was tacked onto the bill but the governor maintains that it would not effect the success or failure of the plan. I'll be interested to see how this turns out 5 to 10 years from now.
* except for the aforementioned raise in taxes caused by an increased enrollment in Medicaid.