Jay Tea at Wizbang proposes something I’ve argued in favor of from time to time, a state-by-state approach to healthcare reform:
Why not ask the legislatures of the several states to each take a stab at reforming health insurance coverage? Some states will tell DC to go pound sand, but most states would probably be willing — hell, quite a few have done so already. Let them try their various approaches for a few years, then have the federal government pull the data and see what is working, and what isn’t.
Further, the states are considerably more responsive than the federal government. Should problems be discovered, the states can work on fixing them faster than the federal government. And if you have a problem with the system, it’s a hell of a lot easier to get hold of your state’s elected officials than your Representative or Senators — they’re becoming experts at hiding from their constituents.
And let’s not forget that many of the European nations often cited of examples of “civilized” nations that offer universal health coverage are smaller (both geographically and in population) than a lot of our states.
Finally, the nation is incredibly polarized right now on the issue of health care. (Well, especially on health care, but on most everything right too.) Things aren’t nearly so bad at the state level. There’s a far, far better chance of meaningful reform getting passed in the several states than at the national level.
That’s the method that’s consistent with our society and our general way of doing things here. However, it doesn’t concentrate a lot of power in Washington which as Jay might point out for some is a feature and for some is a bug.
The problem with the state by state approach is twofold. (1) They don’t have the money and most are constitutionally prohibited from deficit spending. (2) Most states are dominated by a small handful of health insurers. Some states have only 1 or 2 health insurance companies.
Presumably, the United States is going to evolve to a universal system along the lines of France or Germany, where everybody buys private insurance and the poor are subsidized for it. A quick Google search gives me that California, for example, is on the high end of health insurance providers with about 15.
The United States, AS A WHOLE, has about 30 health insurance companies. Period.
By way of contrast, Germany has 1100.
The only way to introduce that level of competition in our system is for the Federal government to get involved.
I’m completely in favor of more, smaller insurance companies bank, etc. My take on how the present situation came to be: regulation has tended to promote consolidation.
And I would say that’s impossible to fix without federal involvement due to the way the Constitution is set up.
I don’t oppose the involvement of the federal government but I think I’d like to see that involvement take a different form than you seem to, Alex. I gather than you have a lot more confidence in the federal government’s ability to administer large bureaucracies than I do.
Over the course of my career, I have dealt with many bureaucracies, large and small, public and private, profit and non-profit. I am always pleasantly surprised by the relative efficiency and competence of the Federal government versus other organizations–including the private sector.
This is a good idea, and in a sense, it’s my “back-up” plan for universal health care. Basically, allow the states to get a waiver so they can use all federal grants related to health care (although presumably Medicare wouldn’t fall into this, even though it probably should eventually) in a program of their own design (and raise funding in terms of grants), provided they meet a set of standards for aiming for universal coverage and care.
That’s actually what the Canadian system is right now – the provinces create and run their single-payer plans, and in exchange for meeting some rules in the Canada Health Act they get federal funding (meeting that theoretically, a province could reject federal funding and dismantle their program – although none have shown inclination to seriously do so).
The main niggling issue with that is that you’d end up with some serious diversification across fifty states, which is good for experimentation but hell on bureaucracy. It might be a wise idea to allow neighboring states to enter “compacts” to operate regional efforts and pools along these lines.
Part of my proposal all along has been an exemption for individual states. The only rules they should need to follow are 1) Everyone gets covered and 2) they have one year to get it going. I have been disappointed that so few states have already tried this.
Steve