An Economic History of Health Care in Massachusetts 1990-2000

Author: Jerome H. Grossman, M.D.

This report examines the Massachusetts health care system during the tumultuous period from the late 1980s to the close of the 1990s. This timeframe begins with the attempt in 1988 to become the first state in the country to ensure universal entitlement to health insurance and ends with the fiscal crisis of Harvard Pilgrim Health Care and the general climate of uncertainty and angst that has beset the state’s health care system. Apart from describing the important events of this timeframe—and highlighting the pivotal decisions of earlier decades that set the stage for this period of upheaval—the report aims to illustrate more broadly ways in which the health care system in Massachusetts (and in the United States generally) has evolved in a highly dysfunctional manner, one which made some of the marked changes of the past decade not only inevitable but in many respects desirable.

An Economic History of Health Care in Massachusetts 1990-2000