A friend of mine of East Coast extraction recently returned from a trip to Boston. He was visiting relations there who are, as is he, well-educated, successful, professionals. Apparently, dinner-table conversation turned to Obamacare (PPACA, if you insist), and his relatives all defended Massachusetts’s health-care “reform” and the controversial federal law which is largely derived therefrom.

“They’re all Democrats,” he told me. “They can’t imagine being anything else. In Massachusetts, almost everybody is a Democrat.”

Furthermore, my friend, a surgeon, pointed out the high concentration of hospitals and medical-research facilities in and around Boston, the high-tech sector, and the long-established concentration of wealth.

“This sort of thing (government-dominated, centralized, mandated health care) can work there. But out here, we don’t have all of that money, and we don’t have the concentration of medical facilities. Most important, people — most people — moved here for a reason. They want to be left alone. They don’t want the government telling them what to do. I didn’t really realize that until I moved here. You can’t impose a plan like this on the people who live out here.”

By the way, wealth plays a major role, so long as it lasts, that is. The Massachusetts legislation was sold as a way to reduce health care costs, but the Beacon Hill Institute points out that “[t]he law did not bring about a promised reduction in health care expenditures. Rather, it permitted the state legislature and governor to expand health insurance coverage to almost all residents, while imposing more than $8 billion in new health care costs to the federal government and on state residents and businesses.” The Cato Institute agrees, finding (PDF) “There are reasons to be concerned about the rapidly growing expense of this program, which even advocates such as Gruber (2009) admit were put aside in the quest for universal coverage.” Driving health care costs through the ceiling isn’t an option in a country that is, simply, broke.

My friend, not surprisingly, is no longer a Democrat. He considers himself an independent, and is desperately looking for an excuse to vote Republican this year — an excuse the GOP seems dead-set on denying socially tolerant, free-market-oriented independents with its ongoing efforts to define itself as the party of homicidal religious fanatics.

Yes, government-mandated, centrally controlled health care can “work,” for a time, in a region of subservient forelock-tuggers, and where deep pockets can be picked to fund the whim of the moment. But, even there, funds eventually run out. And, elsewhere, neither people nor finances are likely to cooperate.