Massachusetts gets high marks for the remarkable accomplishment of bringing diverse stakeholders together to pass legislation which achieved near universal insurance coverage. But the legislation did not address the question of "coverage for what" nor did it challenge the way in which health care is delivered today. Unless we are willing to actually define what we mean by a health care "benefit" and to restructure the inefficient system through which it is currently delivered, we cannot resolve this crisis.

Paying for universal coverage without defining what is covered is like trying to figure out the budget for a banquet without a menu. We do need universal access but what we need access to is not the current system. We need access to a system that produces wellness, not one that simply reacts to sickness. Without elevating this debate above the question of insurance coverage, costs will continue to escalate and the current unsustainable financial equation will not change.

See John Kitzhaber's blog posting on the Massachusetts legislation.