Should Health Care Reform Be Left To The States?

Jon Kingsdale, executive director of the Mass. Health Insurance Connector Authority, tells The Washington Post that there isn't enough "political will" in most states to carry out health care reform. Still, the paper reports, with national reform in limbo, attention is turning to the states, and debate is raging on which approaches to reform really work best. Reporter Alec MacGillis writes:

Advocates of a state-by-state approach are invoking welfare reform, which originated in the states, and education, an area in which the federal government goads states to improve but lets them choose their own approaches. Imposing national health-care reform, they argue, ignores local variations in health-care markets and politics.

"Let's let the states come up with the solutions," said Missouri state Senate President Charlie Shields (R). "There's a lot of solutions out there, but the solutions vary state by state."

Supporters of a national approach counter that relying on states would mean accepting the status quo for years to come. A state-by-state approach makes it harder to rein in health costs with systemwide reforms. And cash-strapped states are in no position to launch new initiatives. Shields acknowledges that Missouri won't be expanding insurance coverage to more people anytime soon, saying, "Other than just doing the right thing, there's not much incentive financially to do that right now."

Another problem is that "successful" reform appears to be largely subjective. The Post notes, for instance, that, "Texas Gov. Rick Perry lauds his state's health-care system, even though the state has the highest uninsured rate in the nation."

This program aired on February 15, 2010. The audio for this program is not available.


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