Good start:

Massachusetts’s pioneering plan to provide universal health coverage is off to a good start and is heartening evidence

that national health care reform may be possible if sufficient skill and determination are applied to forge a political consensus.

The state requires that all residents take out health insurance or suffer tax penalties if they don’t. It also requires employers to offer coverage to their workers or make alternative payments if they don’t. It has already covered some 350,000 of the uninsured — more than half of the roughly 650,000 residents who were estimated to be uninsured when the plan began in 2006. Two-thirds of the new enrolees signed up for subsidised coverage available to low-income people. The rest signed up for private commercial insurance.

The chief criticism against the plan is that costs have risen fast, forcing the state to raise its spending estimates for the current fiscal year from $472 million to $625 million and from $725 million to $869 million for next year. The key challenge will be to keep costs under control and find new sources of revenue while maintaining widespread support for the programme. How well Massachusetts handles that challenge will determine whether its pioneering health plan falls into a financial pit or points the way toward universal coverage. — The New York Times