While hardly noticed here, an innovative legislative proposal to provide health care for every Massachusetts resident made global news last week. Sponsored by Republican Governor Mitt Romney, who it is rumoured will run for the US presidency in 2008, the plan is a dramatic breakthrough idea that also emphasises state, employer, and individual personal responsibility to obtain health care.

The Massachusetts plan would allow uninsured people earning less than the federal poverty level to obtain subsidised policies that have no premiums and pay small co-payments for emergency room visits and other services. Those residents earning above the poverty threshold to three times that amount would pay premiums based on a tiered ability-to-pay thresholds. Residents will be required to provide proof of their health insurance policies on their state income tax returns, losing credits if they have no insurance. Waivers will be given to those who cannot obtain health insurance and employers may be fined for each employee not provided with health insurance.

US Federal Poverty Level defined. Latest statistics from the United States Census Bureau place the official poverty rate percentage for 2004 at 12.7 percent of the population. This puts the number of people officially living in poverty in the United States at 37 million. In real dollar terms, a family of four people survives on an annual average income USD19, 307.

It is a telling commentary on the nation as a whole that health care benefit statistics are even grimmer. Out of a current estimated US population of 296 million, 45 million (15 percent) have no health insurance; Eight million of these are children under 18.

No Benefits and No Job Security. In her seriously sad, but illuminating book, 'Nickel and Dimed, On (Not) Getting by in America' Barbara Ehrenreich documents with her own actual physical research (labour) that toiling at the economy's lower depths with exhausting 14 or more hours work days is barely enough to get by. She has coined the saying that for this segment of the US population that 'you need two jobs just to live indoors.' There is no money left for health insurance, not now or later, for many of these personable dignified people, who clean homes (and bathrooms), wait tables, wash dishes, work in nursing home kitchens, taking unskilled jobs because they have to. Nor do employers in these industries offer any in benefit packages, if the employee declines to contribute. Dr. Ehrenreich is touchingly aware that at the end of her three-month research project, employed as a $7.00 per hour worker, she can return to the security of her middle-class life.

Even for US companies that do provide health and other medical benefits, costs are still increasing at an unpalatable average rate of 15 percent annually (AARP). Becoming more incisive in their quest to control these costs, some US employers are strongly urging employees to curb unhealthy lifestyle behaviour like smoking; self-selecting healthier individuals during job interviews; by choosing not to hire smokers; and by firing those smokers, for instance, that decline to participate in tobacco-use cessation programmes. While this new attempt to control employees' behaviour is still to be determined by litigation in the courts, these new cost containment tactics speak to these times of companies competing with intense global competition and quest to maintain profits. As one article speculated, 'will those individuals who eat more than a Big Mac a day be next?'

Bermudian residents are more fortunate. When you compare the number of uninsured people in the US, then translate that percentage into the Bermudian population, it would mean that 10,000 residents (out of approximately 65,000) with no health care benefits. But, this is not the case here!

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