I have been accused of being something of a troglodyte for not whole heartedly embracing the Massachusetts Health Care Reform act, including because it puts the cart before the horse in failing to recognize (and address) the fact that rapidly rising health care costs are the real problem driving accessibility and also because the statute is preempted, which matters because the problems it is trying to address can only really be targeted successfully in the long run on a national basis rather than on this type of state by state ad hoc approach, which Congress long ago precluded by means of ERISA preemption. Compare those posts to this and you will see that, yes indeed, it is costs that drive the problem and that the solution to that lies on a national basis, not a state by state one (see for instance, this recent column noting the impact of costs on the implementation of the Massachusetts Health Care Reform act, an issue much better addressed across the entire national pool of the insured).