In Massachusetts, where we have some of the most patient-oriented health care laws - no issues with pre-existing conditions for years already, mandatory health insurance, etc - cities and towns, like everywhere in the country, offer health insurance to their employees and are slowly going broke as a result. The unions have had the right for years to veto changes in health insurance. So if the cities and towns try to cut back on insurance or require higher co-payments or portion of insurance paid by the employees, the unions would veto it.
Some towns are currently paying 20% of their budgets for health insurance for the employees and pay for 90% of the insurance premiums. And the employees and retirees pay $5 co-payments. After decades of huge insurance premium increases the towns and cities are cutting back on services and thousands enjoy health insurance on the town's dime. Its not just employees but retirees who enjoy health insurance for life. And after 10 years of employment an employee can retire and keep their insurance.
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The governor, Deval Patrick, who just was elected for his second term, and has announced he will not run again, has split with the unions on this. He wants the towns and cities to be able to change the system so that the unions can't veto changes to health insurance. This change will only happen if it is legislated and this is the first step. This system is an archaic leftover from times when health insurance was affordable. This is a system which needs change, now.
But there is also a caution here. As health care reform comes into play, we want to make sure that we do not overburden our federal, state, or city governments with the costs and we do not back ourselves into a similar position. The insurance companies who set the premiums should not be able to make a profit at the expense of our citizens or government. This will be a tricky line to balance - offer insurance to all and keep costs under control.