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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