Lew Wallace

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That quote by Lew Wallace, former governor of New Mexico and author of "Ben Hur," is perhaps the most well-known adage about our state. The "elsewhere" Wallace referred to is no doubt other states, particularly in the eastern region, from where businessmen journeyed to seek fortuitous opportunities in the wild frontier. And there was no shortage of opinions on the subject of how things should be on the prairie.

Now Massachusetts has taken a bold step to decrease the number of people without health care insurance - a major problem nationally and an even more aggravating one for New Mexico. The Bay State deserves credit for tackling this elusive problem in bipartisan fashion. Its Legislature voted 191-2 for a law that provides "universal" access to "affordable, quality accountable health care."

Here is what's unique about the Massachusetts plan.

First, Massachusetts recognized that in every segment of the population there is a different reason why people are not insured. As a result, there is a special package of low-cost health coverage created for the age group between 19 and 26.

Second, there are sliding scale subsidies for those who cannot afford coverage or need help paying. An individual earning below 100 percent of the poverty level gets free health care. If an individual earns $19,600 a year, his or her monthly premium is $46. Premiums increase with the ability to pay.

Third, coverage follows employees. Once they are in a plan with an assigned doctor, they stay there regardless of employment changes.

Fourth, it is now state law that everyone must have health insurance, which is enforced through the personal income tax program. By July 1, 2007, failure to comply results in losing your personal income tax exemption. By July 1, 2008, penalties will be levied that are up to 50 percent of the cost of purchasing health insurance.

Would a duplicate version of the Massachusetts plan work in New Mexico?

I'm skeptical. The percentage of uninsured in Massachusetts is only 10 percent. In New Mexico that figure is more than twice as high, about 23 percent - almost one in four. Our associated costs and lack of financial contributions are more severe than in Massachusetts. Another problem for New Mexico is that the local proponents of single-payer, government-run health care are fanatical about that controversial approach and have been unwilling, at least until now, to compromise in a way that salvages a market-based approach.

To parrot Wallace, one size doesn't fit all. But we could learn a thing or two from Massachusetts. First and foremost, we should immerse ourselves in understanding how the money flows, follow the dollars and reform the insurance market to create unique, customized plans with benefits tailored to different segments of New Mexico's population. We should be willing to subsidize to the hilt those people who are unable to pay.

The focus of the Massachusetts solution was aimed just as much at the insured as it was the uninsured, which changed the perspective of the approach and helped produce a solution that is perceived as equitable. Most employers are now mandated to provide health coverage or pay a stiff penalty. Everyone gave up something.

There are innovative aspects of the Bay State's plan that should be considered for whatever health-care reform framework New Mexico adopts, such as factoring certain lifestyle choices into an individual's premium - an idea whose time has come. But whatever path we take, it should be our own.

Bullington is senior policy adviser and director of New Mexico government relations for the Brownstein, Hyatt & Farber law firm. He writes this column weekly.