Optimism that health care will pass may be rising
, but the ever
-contentious health care debate
is still surfacing new ideas. The latest, gaining some steam
late in the game as reform creeps through the Senate, is to have states
design and run their own health care programs. Debate over the
effectiveness of state plans hinges on a few past state plans in Texas,
Tennessee, and Massachusetts. Are they models to follow, lessons of how
to do better, or warnings against more state-run health care?
- Senator Carper's Plan David Sessions explains
the proposal Carper put forth to run state-by-state insurance. "One
Senator has a new idea: let the states each run their own
government health care plan. The proposal by Sen. Tom Carper (D-Del.)
is earning warm praise from centrist Democrats as a way to both expand
coverage and spur competition in the private market," he writes. "A
plan like the one Carper is proposing could leave health care
coverage up to the whims of the governor or the financial condition of
the state, and would create a messy situation for people who moved
- State-Tailored Plans More Efficient Ezra Klein, interviewing
Carper, asked, "Doesn't that move us in the wrong direction? Isn't the
problem that the system is too fragmented and diffuse?" Carper
responded, "That's an argument to consider. But there's something to be
choice and letting them tailor it for some states rather than for
others. What might work well for a state in the Northwest or the
Midwest might not work that well in New York or New Jersey."
- State Plans Failed Peter Suderman, surveying
past state-run plans in the Wall Street Journal, says they don't work.
"The results have been dramatically increased premiums in the
market, spiraling public health-care costs, and reduced access to care.
In other words: The reforms have failed," he writes. "A 2008 analysis
by Kaiser Permanente's Patricia Lynch published by
Health Affairs noted that in addition to Washington and New York, the
individual insurance markets in Kentucky, Maine, Massachusetts, New
Hampshire, New Jersey and Vermont 'deteriorated' after the enactment of
guaranteed issue. Individual insurance became significantly more
expensive and there was no significant decrease in the number of
- The Texas Disaster Cappy McGarr reviews
the Texas health care initiative in the New York Times. In the 1990s,
McGarr founded and ran a state-run "purchasing alliance" akin to the
"exchanges" proposed in Congress. McGarr says it worked well initially
but "ultimately failed" because they could not overcome the power of
insurance companies. "Texas wasn't the only state to see its insurance
Florida and North Carolina were also unsuccessful. And California,
which had the first exchange (established in 1992) and the largest
market, shut its doors in 2006. All these state exchanges failed for
the same reason: cherry-picking by insurers outside the exchange. If
Congress now creates new exchanges, as seems increasingly likely, it
must prevent this phenomenon by setting two national rules: Insurers
have to accept everyone and have to charge everyone the same rates
regardless of health status."
- Will Federal Plan Reproduce Failed State Plans? Tim Pawlenty,
the Republican governor of Minnesota, says Tennessee and Massachusetts
are warnings. "We have essentially Obamacare that's been deployed in
two states in
major ways. One is in Tennessee. We have a Democratic governor, Phil
Bredesen, said hey, look, we tried this cost savings as a way to fund a
major overhaul of health care; it didn't work," Pawlenty said on ABC's
This Week. "We have another state, Massachusetts, who tried essentially
thing. They have the most expensive health care in the country. They
have increasing waiting lines, and it's not working."
- White House Learned From TN and MA Obama's Health and Human Services Secretary, Kathleen Sebelius, rebuts Pawlenty but insists on a federal plan. "The Tennessee experiment is really different from anything that's
been talked about here. It's something that really was an attempt to
make a vastly over-expensive Medicaid system work. It did crash and
burn. It's different than any place in the country, I would suggest,
that has done a much better job at expanding care and holding their
costs. In Massachusetts, they readily admit that they expanded care and
didn't look at the cost side of the puzzle, which is why I think the
president continues to suggest that anything we do, it has to bend the
cost curve," she said. "We need a national strategy."
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