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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Limits of States as ‘Labs’ for Health Care Reform

One of the more comforting notions being bandied about the print pundocracy is that the states can play a leadership role as “policy labs” in pioneering health care reforms. Massachusetts is the most-frequently-cited poster boy for this meme, and it seems likely that Mitt Romney, now leading the Republican field in early-primary states, will make emulating the Massachusetts system a cornerstone of his campaign, should he win the GOP presidential nomination.
Climbing on this particular bandwagon may not be such a great strategy for Dems, if Ezra Klein is right. Klein’s Washington Monthly article “Over Stated: Why the ‘laboratories of democracy’ can’t achieve universal health care” pinpoints some serious flaws in the “letting the states take the lead” strategy of health care refom. As Klein explains:

The idea of giving universal health care a little more time in the laboratories of democracy may sound tempting to certain cautious, bipartisanship-loving Beltway observers. But letting states continue to take the lead would be disastrous, for one very simple reason: providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own. The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house—in this case the insurers, the providers, and other agents of the status quo—always wins. The new raft of reforms may prove different, but they probably won’t. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will.

Klein expounds on the initially-promising, but ultimately-disappointing history of health care reforms adopted by Washington, Hawaii, Tennessee and Oregon. He notes that Massachusetts is not a representative state for a ‘lab’ because, unlike many states, it had a small base of uninsured to begin with and plenty of money. He also discusses serious problems with current statewide health care reforms pending in California and Illinois.
Klein has identified important limitations of systemic health care reform in the states, and he makes a convincing argument that the states really can’t lead the way to universal coverage. This is not the same thing as saying the states have no role to play in pioneering piecemeal reforms on the road to universal health care. A round-up of interesting incremental reforms at the state level would provide a welcome addition to the debate.

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