Jeff Jacoby
What is the best way to make sure that Americans with chronic medical conditions -- those most likely to need costly or frequent health care -- can afford the insurance they need to meet their bills? The conventional answer, reflected in Mitt Romney's 2006 health-care reform law in Massachusetts and the federal overhaul signed by Barack Obama in 2010, contains these ingredients:

(1) Require everyone to have health insurance, with subsidized plans for low-income citizens. (2) Compel insurers to accept anybody who applies for coverage and to charge roughly the same premium for everyone, regardless of health status. (3) Make all health plans cover a fixed array of medical treatments, providers, and conditions that many customers may not need or want.

The orthodox view, in short, is that to shield people with serious medical needs from undue financial hardship we must suppress the normal workings of a free market -- supply and demand, competition, flexible prices. There's just one problem with this approach: It doesn't work.

Six years after RomneyCare became law, health insurance coverage in Massachusetts is all but universal. Yet a new statewide survey finds that those most in need of medical care are finding it harder than ever to pay for. According to the study, which was directed by researchers at the Harvard School of Public Health and sponsored by WBUR, the Blue Cross Blue Shield of Massachusetts Foundation, and the Robert Wood ­Johnson Foundation, 78 percent of sick adults consider health care costs a serious (50 percent say very serious) problem in Massachusetts. And far from seeing improvement, nearly two-thirds of sick adults say the problem has only gotten worse over the past five years.

This wasn't supposed to happen. Romney was confident his law would ease the pressure of medical costs. "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced," he optimistically forecast in 2006 . Yet today 14 percent of sick adults in Massachusetts report being unable to get medical care they needed at some point over the past 12 months, usually for financial reasons. About half of those who went untreated said they couldn't afford the out-of-pocket costs; another 21 percent said their insurer wouldn't pay for the test or treatment.

Jeff Jacoby

Jeff Jacoby is an Op-Ed writer for the Boston Globe, a radio political commentator, and a contributing columnist for