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President Obama’s health care reform is the law of the land. Yet in Massachusetts, birthplace of yet another national reform, the showdown between insurers and the insured is just beginning.

Last month after the national Blue Cross Blue Shield group arguably reinvigorated Washington into passing health reform because of outrageous rate hikes, the commonwealth’s insurers, including the local Blue Cross, Harvard Pilgrim and Neighborhood Health, submitted for state review hikes as high as 32 percent. Governor Patrick’s health regulator refused to sign off on them, prompting a lawsuit from insurance companies that was expected and even understandable.

But the companies responded by refusing to write new policies. New customers falling in certain ranges of need could not apply for coverage. The insurers’ shame lies in that not only are Bay Staters required to have coverage under the state’s landmark mandate, but also in that insurance is there for a reason—it saves lives.

The companies who raised rates to stay afloat should have more concern for writing policies than the rest of us. Is that not why we put up with them? In buying insurance at all, we buy from the only business model that actively aims for the consumer’s lack and loss—except for gambling, of course. But only when Speaker DeLeo proposes betting human lives at the racetracks will insurers lose their dishonorable distinction.

This week Judge Stephen E. Neel rejected the plea to uphold the price increases and sent the case back to the executive review process. In addition, using a powerful tool in the Massachusetts system that unfortunately has not yet gotten to the federal level, the administration ordered the companies to return to granting coverage or face heavy fines. The irony of a public advocate admonishing the wealthy to work, to do their jobs, is the only satisfaction downtrodden citizens got from this disgraceful attempt.

While Patrick and his advisers may regret getting more of a headache than they bargained for in an election year, the citizens of Massachusetts should hope the governor continues to succeed. Patrick’s track record on health care is possibly his most winning attribute—and voters should not forget it when he asks reelection and their firm support against Charlie Baker, a former CEO at, yes, Harvard Pilgrim.

This month, even with its consequences, is a mere preview of November. Massachusetts must choose between lifting society’s bottom rungs or Big Blue’s bottom line.