US: Massachusetts is to become the first American state to introduce a universal healthcare system, requiring all citizens to take out health insurance and subsidising those too poor to pay for it.
State legislators approved almost unanimously a measure unique in the US which includes state subsidies to insurance companies for lower-cost health plans and fines for individuals who fail to take out health insurance.
Republican governor Mitt Romney compared the plan to car insurance, saying: "We insist that everybody who drives a car has insurance, and cars are a lot less expensive than people."
An estimated 45 million Americans have no health insurance but successive federal governments have failed to win support for plans to deal with the problem. Maine and Hawaii require all employers to provide health coverage for their workers but many individuals in both states remain without insurance.
The Massachusetts plan pleases Republicans by requiring individuals to take responsibility for their health insurance but satisfies Democrats by ensuring that those on lower incomes will have their healthcare premiums paid by the state.
"This really is a landmark for our state because proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover," Mr Romney said.
Massachusetts business groups gave the plan a cautious welcome, although some expressed concern about penalties on companies with more than 11 employees that do not provide workers with health coverage.
Employers whose uninsured workers use emergency medical facilities would have to pay up to 100 per cent of the cost of such treatment exceeding $50,000.
An estimated 500,000 of Massachusetts' 6.4 million citizens are without health insurance and some healthcare experts suggested that a planned $1 billion in state spending on the uninsured was inadequate.
Most of the money will come from cuts in existing programmes, with the state allocating just $125 million in new funding.
Opinion polls show that healthcare provision is the political issue Americans care most about but federal efforts to create a universal healthcare system in recent years have failed.
President Bill Clinton abandoned a comprehensive healthcare reform under pressure from Congress after a well-funded campaign against his plans by the private healthcare industry.