Health care is the elephant in the room. For individuals, nothing is more intensely personal, more urgent, and more closely linked to self-esteem and dignity than the ability to get the health care they need when they need it. For state government, health care finance muscles its way to center stage in deliberations over budgetary priorities. And for Massachusetts as a whole, leadership and innovation in health care have long been fundamental to our economy and to our sense of identity. Health care is an issue we can’t afford to get wrong.

For middle-class families, health care is a source of angst and anxiety. It’s a reason to cling to a job that provides coverage, and to worry about losing it. It’s a reason that salaries don’t go up, or raises are offset by higher premiums or co-payments. For employers, health care is an expense that is out of control. It can be the deciding factor against raising wages or hiring new employees. For hospitals and other providers, health care spending is a referendum on their performance and, in some cases, a verdict on their very existence.

As Michael Jonas reports in this issue, the future may force consumers to take on the unfamiliar task of deciding how much to invest in their own health care. Not unlike the transition from company pensions to 401(k)s, we are seeing the individual thrust into the great societal debate over how to provide care and security in an uncertain, and increasingly costly, world. How prepared are any of us to decide what our own health is worth, and how much society should spend securing it?

These are the questions and concerns that motivate this special issue of CommonWealth. It is only the second extra edition in the magazine’s eight-year history, and the topic–health care–is one of few that, like education reform two years ago, legitimately commands the attention of a full issue unto itself. Cost, quality, and coverage are the three legs of the health care stool, and there is no responsible account of today’s health care conundrum that does not address all three. The articles, analyses, and commentaries in this issue take all three fully into account, and if they chart no clear way forward, it is because they give full respect to each.

This special issue of CommonWealth is made possible by the most remarkable consortium ever to fund a publication on health care. The 28 sponsors of this issue represent the full spectrum of interests involved–providers, insurers, employers, labor unions, consumers. That all of these groups, with their varied viewpoints, have made an investment in an independent journalistic investigation into issues in which they have so much at stake, with no promise of editorial control or influence, is a testament to their civic-mindedness. We thank them for their generosity and support, and for their faith in CommonWealth.

This issue is by no means CommonWealth‘s last word on the subject. Given the centrality of health care to the Commonwealth’s budget, economy, and quality of life, the magazine will be treating this extra edition not as the end of its coverage but the beginning. The life sciences are the future–of the Commonwealth, and of its people–and CommonWealth will be there every step of the way, taking stock of progress and asking difficult questions.

   Ian Bowles