Massachusetts isn't a great benchmark to see if this scheme would work on a nation-wide level:

It's fairly homogenous - not a large variety of socioeconomic variety

It's relatively affluent - lots of large employers and high-paying jobs

It started out with a high level of the insured - The statistic I heard was that somewhere around 92% of all citizens already had some kind of health care, the new scheme increased that to 98%

It's geographically small and densely populated

If they can get a similar system up and running in California or Texas, I could see it working everywhere else. Massachusetts isn't a good indicator of effectiveness.

This all ignores the other problem with the federal reform - it does nothing to address the high cost of health care, it only puts a band-aid on the insurance problem. Health care costs continue to rise, and forcing people to buy it isn't going to do anything to decrease the price [[why would an insurer lower costs - people *have* to buy their product now)