I'm off to the Bridging the Gaps conference, where I'm speaking on a panel about state and federal solutions to the health care crisis. For those interested, here are my opening remarks:
I'm here, I think, to be the Grinch. We've got all these great universal bills passing at the state level, and I'm here to tell you that, well, they are pretty great, but they're not going to work. It didn't work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn't work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state's revenues dropped. It didn't work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.
The plans fall for a few small reasons, and one big one. The big one is that states don't have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don't exist the state can't borrow the money. So they dismantle the program. It's happened time and time again -- in some states, like Oregon, more than once.
Moreover, you don't really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access – it's actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don't have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don't trust them to fundamentally reform the system.
Now, folks make a good point: Health care reform has failed at the federal level time and again. The filibuster knocks it out. You'll never pass it. States are the only hope. To that I'd say two things: One, if you think these red states will never embrace health reform, then they're not going to do it on the state level, either, and I'm not comfortable with a solution that means Texas and Arkansas and North Carolina are left out. So that's point one. Point two is that I think you can have federal reform. More than that, you will. It's true that federal efforts have failed before. But look closer.
