The plan's biggest idea is the individual mandate. When the law goes into effect in July 2007, every resident will have to have health insurance. Residents who don't have an employer-provided scheme and who are ineligible for Medicare or Medicaid will have to buy insurance for themselves. People not poor enough to qualify for Medicaid but who cannot afford private insurance unassisted will be subsidized on a sliding scale. People on medium or higher incomes will have to buy a plan on their own.

The idea is that the $1 Billion dollars currently used to pay form emergency (room) treatment for the un- and underinsured - an amount which the insured and the state's taxpayers have to bear - can be used to offest the news subsidy. There are also plans to allow insurance companies to provide plans with "higher deductibles and co-payments, stricter limits on provider networks, and fewer mandated benefits", as well a "levy" (read tax) on "firms with more than 10 employees that fail to provide health insurance: They will have to pay an annual fee ..., of up to $295 per worker."

And while Cook believes that "the Romney plan is that it includes some good new ideas and will be a fascinating experiment", he remains unconvinced about its chances of success:

But will it work? If extending coverage were the only aim, the plan would get a good grade. But wider coverage is only one of the tests facing the country's health care system. The other is what it costs, and is going to cost in future.

His recommendation is one that I think is correct but not politically tenable- getting employers out of the business of insuring their employees and making individuals more personally and financially responsible for their healthcare:

One implication is clear: A system that is already fearsomely complicated even as a blueprint is likely to become more so in execution. More important, none of those three responses actually addresses the underlying cost-control problem. There are three broad approaches to the issue of system-wide costs. One is to overthrow the private market model altogether -- still unthinkable in the United States. Another is to move in the direction of more heavily managed competition -- which has been tried, in the form of HMOs, and was unpopular. The other is to confront people more directly with the cost of their health care, so that they economize on it, and to pressure providers to compete on price. For this to happen, people, not employers, need to be paying directly for their own health insurance. To curb overall health costs, to put users back in control of a real market, and to build universal access into the basic structure of the system, you have to get employers out of the health insurance decision. Once you do that, Massachusetts has some good ideas about what you do next.

While this sound sensible to me, but I find it hard to see how it will ever come to pass. The consensus seems to be right now that making large employers like Wal-Mart pay more of their "Fair Share" is the solution to the national health care "crisis."

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