Letting the states decide healthcare reform

by Terry O’Keefe

The State of Vermont just passed the nation’s first single-payer universal healthcare system. While there are still some bureaucratic hurdles to cross, Vermont will soon install the kind of system that healthcare progressives have been drooling about for decades.

And whether you think that puts Vermont on the high road to healthcare nirvana, or the low road to socialized medicine, I think we all owe Vermont a big vote of thanks for trying something new. And pretty soon, we will know if single payer healthcare is as cost-effective as its proponents claim.

We have suffered through several decades of healthcare studies, proposals, propaganda, toxic public debates, and a questionable piece of federal legislation. Maybe it’s better to get at the truth about healthcare reform the old fashioned way – by putting a series of experiments in the field and letting the results speak for themselves.

So let’s hope that a slew of states will follow Vermont’s lead. Congressman Ryan’s home state of Wisconsin might want to follow his dream and substitute vouchers for Medicare. Ohio might choose to replace Medicaid with block grants. Maybe Mississippi will turn its healthcare system over to private insurance companies – and we’ll see whether privatization on the grand scale really works. Or mighty Maine might get permission to buy prescription drugs from Canada, and we’ll find out firsthand how much the drug companies overcharge us.

The US is perfectly positioned to experiment with healthcare in this way. We have 50 sovereign states, and each one is already deeply enmeshed in managing its own statewide healthcare programs. So, the experiments in Vermont – and in Massachusetts as well – aren’t costing us a dime. And even if they did, it would be a sensible investment in finding our way to the right answers about healthcare.

When I was growing up in New York, we kids used to have endless arguments about whether the Dodgers were a better baseball team than the Yankees or the Giants. But in the end, those debates got settled the only way they could – on the playing field.

Seems to me that’s a pretty savvy prescription for healthcare reform.

Terry O’Keefe is a writer and business consultant with an interest in finding new approaches to public policy and change.

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  • http://fertilityfile.com IVF-MD

    I’m all for state-by-state choices, both from a moral perspective of allowing more freedom of choice for people, but also from a practical perspective of gaining better quality information about which policies are better. It would be even be better to define prospectively some end points to study as a comparison. And to choose another state and have it’s policies to be the polar opposite (less government, less taxation, less mandates, less regulation). Then we could have the best comparison.

  • Brian

    State experimentation is a great idea—except that the only experiments that the Obama administration will allow are those that are more liberal than the ACA. Governors have been begging for the latitude to experiment in their states with Medicaid, but the onerous CMS waiver process stifles innovation—unless of course it’s an idea that the administration was already foaming at the mouth over but couldn’t pass on a national scale.

    • ninguem

      What Brian said.

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      First of all the Vermont legislation cannot begin implementation before 2013 (one year after the next election). Second, waivers to states to do their own thing cannot be granted before 2017. Not sure which administration will be in place by then, but it most certainly will not be Mr. Obama.

  • http://www.TheWriteTreatment.com Barbara Hales

    Terry, the next question is whether people finding an adjacent state’s health plan to be attractive, would be able to avail themselves of that plan. This was a current problem with insurance before health reform took hold and kept the competitive cost up by not allowing interstate trade of insurance coverage.
    Will we now see people relocate their homes to suit their healthcare needs?
    This will be interesting to follow.
    -Barbara Hales

  • http://www.youtube.com/watch?v=ji_G0MqAqq8 AustrianSchool

    Healthcare should be handled at the discretion of the individual states, not the federal government, per the constitution 10th Amemndement

  • jim jaffe

    no one argues about the wisdom of state experimentation, but it would be a mistake to think that any lessons learned will be quickly learned. Maryland has been regulating hospital rates for a quarter century with a fair degree of success, but no state has followed them and few who live outside the state are even aware of the system. its not unlike the practice of medicine in that building a better mousetrap doesn’t guarantee that the world will be a path to your door.

  • Dorothy Green

    I agree with Tony – for profit insurance has to go regardless of the state – I hope they leave the warm ones as well. I believe even employer based insurance has to go eventually to allow more mobility in this country. In addition, even if these issues along with corruption, unnecessary tests etc. are purged from Medicare and Medicaid there is still the looming cost of chronic preventive diseases – health insurers know this well – bypass surgery is more commom, and hence, more costly overall than treating a person who ate right, exercised but damn, had pancreatic cancer.

    We know the chronic preventive diseases are mostly caused by addictive substances – tobacco (we have done quite well in decreasing this with an upfront and personal significant amount of money and message) but now mostly processed sugar, fats, and salt.

    None of these addictive substances can be prohibited. The “war on drugs” cannot be won. Nor will all the kings of diets or all the TV eat right shows slow the US weight gain that is the greatest RISK in disease and hence the greatest cost to taxpayers.

    I hope Vermont imposes at least a modest tax on sugar to help pay their health bills and also add a strong message to their food packages using the Nutrition Facts Grams/mg as the base for cost (pennies/ounce doesn’t make sense) along with a strong message on the package that this is your RISK amount. I have shared most details of this idea before.

    Anyway, did you all know that Mass healthcare got big bucks from the feds to start their program. We Americas, are all in this together. States need to have their own rights but really, doesn’t it make sense to have somethings – like healthcare insurance – be a non-break the budget issue and have some kind of continuity across the board?

    OH! and please send messages to your representatives to stop subsidizing unhealthy food substances.

  • gzuckier

    Kind of like the states can decide on firearm sales regulations; like New York State can try to restrict sales to criminals, but Virginia can supply criminals with firearms wholesale by not enforcing laws agains strawman purchases etc.; then NRA’s politicians can point to this as an example of how gun laws don’t work? Unfortunately, with regulations to establish a strong floor and enforce then, the bad drives out the good; and you’ll find some states mandating policies which cost 50 cents a month, and cover bandaids and aspirin, only. Much as the ability for states to regulate their own financial institutions however they wish has become a loophole for shady companies to exploit.

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