Abstract

When I first heard of the Massachusetts state legislation, two things came to mind. One of them was a piece of Canadian history little known to Americans: universal care in that country began with the Canadian provinces, gradually spreading to its federal government. Is that kind of development possible in the United States? The other was the famous 1932 phrase of Supreme Court Justice Louis Brandeis that the states are the “laboratories of democracy.” Could the Massachusetts law serve as a laboratory for national universal health care? While the two questions are related, they raise different issues. The Canadian example bears on the direction and trajectory of health care reform, not on its content. Brandeis’s phrase encompasses the nature of the reforms. The Massachusetts law is encouraging on both counts, but there are reasons to be hesitant in one’s hopes.