It is a national disgrace that 45 million Americans have no health insurance. Compared with the insured, uninsured children hospitalized with injuries are twice as likely to die, and uninsured women with breast cancer have a 50 percent greater risk of death. Overall, uninsured people receive less preventive care and have higher mortality rates.

So we should applaud Massachusetts policy-makers for developing an innovative state program that may greatly expand health insurance coverage.

But what about the other 49 states or, indeed, the nation as a whole? Will the Massachusetts program serve as a model for them?

The Massachusetts program, enacted in April 2006, requires all residents who can afford health insurance to buy it, and all companies with more than 10 employees to contribute to their employees’ health insurance, or else – in both cases – to pay a financial penalty. The state also has expanded its Medicaid insurance plan to cover additional adults and children and additional medical procedures.

To provide comprehensive, affordable insurance, a new state agency operates a marketplace for insurance plans, allowing individuals and small businesses to choose among plans offered by six pre-approved insurance carriers. A typical premium is $175 per month; for many, the net cost will be only $109, after taking account of favorable tax treatment. For residents under age 26, still lower premiums are available.

Health insurance is free for families with incomes up to 50 percent above the federal poverty level (currently $20,650 for a family of four) and it is subsidized for families with incomes less than three times the poverty level.

The Massachusetts program is expected to raise insurance coverage from 91 percent to about 98 percent of state residents. It will be financed partly through federal funds that previously were needed to pay hospitals for treating the uninsured. It preserves the patient’s ability to choose among doctors and it supplements rather than replaces existing insurance arrangements, so those who are happy with their present doctors and insurance plans can retain them.

The plan became fully effective just this month, but already 155,000 people have enrolled, of the roughly 500,000 previously uninsured. This early success stands in sharp contrast to the record of Maine’s Dirigo program, which began in 2003, but which now enrolls only 15,000 out of roughly 135,000 previously uninsured.

Will the Massachusetts plan be adopted by most other states? While some observers think so, a touch of skepticism is called for.

First, covering the uninsured would be a major financial burden for many states. Most have higher proportions of uninsured residents than Massachusetts: 9 percent of Massachusetts residents were uninsured in 2005, compared with 15 percent nationally and 20 percent or more in several states. And many states already are struggling to balance their budgets – Pennsylvania is an example – and can ill afford a large new spending program.

Second, an unusual political climate prevailed in Massachusetts during development of the plan. Leaders of both parties, determined to improve the state’s health programs, agreed to painful compromises and involved all interested groups – medical providers, health insurance carriers, advocates of the poor and businesses – in the negotiations. In some states, the political parties do not seem ready for painful compromises or inclusive negotiations.

Third, the Massachusetts plan is new, has had only limited road-testing, and could fail somewhere up the road.

To overcome such obstacles, some experts propose adopting the Massachusetts approach at the national level, instead of state by state. This would shift the financial burden from the states to the federal government – but might require controversial changes in federal tax law.

Given all this, other available solutions deserve our attention. Some analysts propose that all households be given health care vouchers. Others recommend various “single-payer” approaches, such as an expansion of Medicare to provide everyone with the benefits that current Medicare beneficiaries receive.

Finally, neither the Massachusetts program nor other proposals for expanded coverage will cure some ills of the present U.S. medical system. Increases in health care costs exceed the economy’s annual rate of growth by 2.5 to 4 percentage points and threaten the future of Medicare. And the whole system suffers from serious quality problems.

Still, Massachusetts did more than propose. It acted, and it might yet achieve nearly universal and comparatively inexpensive coverage; and it retains desirable features of our current system. It, at least, takes a step toward ending the present disgrace of inadequate preventive care and high mortality rates for the uninsured, including children, breast cancer patients and many others.

Edwin Dean, an economist and seasonal resident of Vinalhaven, writes monthly about economic issues.