The great Commonwealth of Massachusetts is now in the spotlight of every state in the United States claiming to have the formula for health care reform. The problem with putting a spotlight on anything is that people from distant vantage points can't see the true details. In an attempt to create a clear picture for health care activists outside of Massachusetts, let's expose what this legislation is all about.

In Massachusetts we are known as a liberal, progressive state. The health care industry accounts for 30 percent of our state's economy. Health care reform has huge ramifications for our state. We have estimates of 550,000 to 750,000 uninsured in Massachusetts.

In the past year and a half we have seen every type of health care reform legislation imaginable find its way to our elected leaders. Every conceivable entity with stakes in this issue has had newsworthy events and meetings with House and Senate representatives. Legislation has included fair share models, single payer plans, voter referendum items to finance these ideas, even clever strategies such as a State Constitutional Amendment to make health care a right in Massachusetts. If any reform dream has danced in your head, it has been attached to a House or Senate bill number here in Massachusetts and been trotted past a few representatives to its black hole in the State House.

What survived were the plans touted by the three amigos of Massachusetts, House Speaker Dimasi, Senate President Traviglini, and Governor Romney. As the egos stroked each other's plans, they went behind closed doors to come up with a compromise plan. The consumer concerns and labor were left out of the dialogue.

Those in on the plan were the Associated Industries of Massachusetts (AIM), Blue Cross/ Blue Shield, Harvard Pilgrim, Partners Healthcare Systems, Massachusetts Hospital Association, and Eli Lilly, the state's largest insurers and hospital entities plus the pharmaceutical company.

The three amigos each had an ideology of their own plans that they would not negotiate. They included personal responsibility, fair share, reducing reliance on the free care pool, forcing this on the uninsured in order to claim we cover 95 percent within three years, and calling it universal. So the plan was sewn together, run through the House and Senate without details or full funding figures to support it, and won 152-2.

The main concern initially was: "We must come up with reform or risk losing 385 million federal Medicaid dollars." With that in mind began the plan. The first step of the plan was to implement the 10 or more employee rule -- if you employ 10 or more people and don't provide health insurance you must contribute $295 per year per employee as a fee to the state (not a tax?).

The next part deals with the uninsured -- requiring them to buy plans from the private insurers depending on income. The insurance plan (let's call it the limited choice plan or the community hospital plan, get the picture?) will be subsidized on a sliding scale from poverty level to 300 percent of poverty level with all others required to buy their own or face $1,000.00 fines. This will be monitored on your state tax return "proof-of-health-insurance" section.

The monies for this new scheme will travel from the public sector to the private insurers via the "Connector" which requires the formation of a new government agency to accomplish this. The third part of this plan is also part of the connector, which diverts money out of the free care pool (uninsured pool) to the private insurers to subsidize those that qualify for subsidies.

So when this bill is signed into law, we will have a two-tier health access system that limits those in the low-end insurance programs to community hospitals and limited doctors. Initial estimates low-ball a plan for an individual at $325 per month and double that a month per family without prescription drug coverage. There are also conditions on the premium with regard to current health conditions. These are based on people in excellent health and age considerations are also factored somehow.

It is not known if those who can't afford health insurance today can possibly afford what is being offered. It may be cheaper to pay the fine.

One thing is clear, the $7.5 million spent on lobbyists last year was the best investment made by the recipients of this plan's jackpot. The insurance companies are the only winners here. They will now be subsidized by that federal/state funding and individual/employer mandates that should stay in the Mass Health system.

John A. Horgan, a Boston telephone worker, is a member of IBEW Local 2222 and active in the Jobs with Justice Healthcare Action Committee.