Keeping an eye on the Massachusetts health care system

The price of gasoline seems to have trumped health insurance in election issues, but it's one of the issues where voters will have the biggest choice

Sen. John McCain wants to make employer-provided health insurance taxable, but then give everyone a $5,000 refundable tax credit, which you can take anywhere to buy the policy you want.

The trouble is, a family health insurance plan costs more than twice that, about $13,000.

Sen. Barack Obama's plan would let people who have employee health insurance keep their plans, plus provide subsidies for those who don't have health insurance, plus make them eligible even if they have a pre-existing condition.

Essentially, he plans to give us all health insurance similar to the one that covers federal employees -- along with the attendant cost.

Meanwhile, one state is performing an experiment that officials are watching with rapt attention.

Massachusetts, when Mitt Romney was governor, set up a universal health insurance system that has cut in half the number of adults who have no health insurance, but has cost more than a third more than initially projected.

The plan, which was disowned by Romney while he was a candidate, but which he has since endorsed, has more of "stick" than the carrot Obama offers in his plan, fining people like the young, who think they'll never be sick, or those who aren't poor enough to qualify for subsidized care but cannot afford insurance.

Those fines, self-assessed on taxpayer's income taxes, raised $9.7 million from 86,000 taxpayers in the first year. The fines will go up each year in hopes people finally see it is cheaper to pay for the insurance than to continue paying penalties.

And, in shades of socialized medicine, some people have trouble finding medical providers and getting appointments, probably because more people have coverage there aren't enough primary care physicians to go around.

Health care and retirement concerns will boom along with the continued aging of the post-World War II babies, but Hillary Clinton wasn't able to ramrod through universal health care during her husband's first term in office, and missed a second chance this election year.

But while energy prices and the wars in Iraq and Afghanistan are getting more headlines, health insurance is an issue that will be with us for years to come.