The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

States’ Health Care Reform Efforts Doomed to Fail?

Posted by Alan on December 19, 2007

I almost hate to bring this up. After all, everyone is so excited (not necessarily supportive, but excited) about Assembly Bill ABX1-1 (Nunez) making it through the California Assembly on Monday. For those not paying attention, ABX1-1 is the compromise health care reform legislation put forward by Speaker Fabian Nunez and Governor Arnold Schwarzenegger. It faces a very uncertain future in the State Senate, where it will be considered in early January. And it is contingent on passage of a financing measure supporters hope to qualify for the November 2008 ballot.

So I feel like the Grinch at the office holiday party, but a strong case can be made that the states are not the place for health care reform. In fact, Ezra Klein, a staff writer at the self-proclaimed liberal American Prospect, has made a strong case states tend to fail at health care reform.  The title of his piece, published in the August/September 2007 edition of the Washington Monthly, sums up his point: “Over Stated: Why the ‘laboratories of democracy’ can’t achieve universal health care.

Mr. Klein describes providing health care for all citizens as being “one of those tasks, like national defense, that the states are simply unequipped to manage on their own.” He then sets out the several failures states have already experienced. Washington State’s “Clintonian-style” program, recent challenges faced by Hawaii, Tennessee’s fiasco called TennCare, and Oregon’s troubled attempt “to do the one thing that really needs doing: controlling costs.” He also points out why Massachusetts’ health plan is unlikely to work in other, more diverse and poorer states. Mr. Klein concludes that the “results are pretty clear: states are no good at delivering universal health care.”

Mr. Klein’s message is that the federal government should implement universal coverage and relieve the states of their impossible quests. He appears to support a government-run system, but that’s not the focus of the article.

Nor should it be the focus of Californians contemplating our own health care reform effort. We have to deal with the issues on the table and there’s substantial momentum now for a state solution. But as California moves forward, we should heed the warning from Washington, Hawaii, Tennessee and Oregon. Budget projections often miss the mark (just look at the surprised look on the faces of California lawmakers learning the state’s budget is $14 billion out-of-whack). Assumptions that make sense on paper don’t always play out the way we expect in the real world. Administrations and policy priorites change.

In other words, the road to state health care reform, paved as it is with good intentions, often leads to unpleasant results.


4 Responses to “States’ Health Care Reform Efforts Doomed to Fail?”

  1. Matt said


    Your post is laughable. “And what you have now is a complete, and total disgrace, and horror show.” That is how you describe our current health insurance. That is an interesting way to put it. “The #1 cause of injury, disability, and DEATH in America is, Health Care.” I would love to see a statistic that backs that up. Why should I pay more money for my insurance because some people don’t take care of themselves? A single payer system is not the way to go. Government managed. What?!?! Is that a joke? Have you been to the DMV lately? Anything government run doesn’t work too well. How can you say that is the only way to go? Nothing is that black and white. And no offense, but Medicare for all disgusts me. The idea that an illegal immigrant can cross a line, have a baby, and all of a sudden my taxes cover that child is ridiculous. I am sure I am not 100% right, but I guarantee you are not even close. The more I read your post the more it amazes me how some people think. “Killing and Ripping you off.” Carriers don’t put a gun to your head and say, “BUY THIS!!!” People need insurance and if they are misinformed or not educated enough to know what they are purchasing, who is to blame? It is sad how people get these ideas in their heads. Morals and ethics are debatable so you really shouldn’t use that as your argument for HR 676. You are trying to get people to cold call about this. Wow. That’s deep. If you have to cold call people to inform them you have a problem with your case. I think you have a lot of good points, don’t get me wrong. I just don’t think the carriers are the only one’s to blame for our current situation. Our population is completely out of shape. Who is to blame for that? Why should a carrier cover someone that is clearly going to cost money? I wouldn’t want that burden, I don’t think you would, and neither does the carrier. We are a capitalistic society and we are surprised that carriers, that run a business, would want to make a profit. Should pharmaceutical companies get to make a profit? How about band-aid companies or Tylenol? These are things that people need when they get sick… insurance….and oh my god…..they make a profit. Who would have thought?

  2. James Edward Hicks III said

    Jack be careful your going to have a stroke. I hope you have gotten all that off your chest but frankly I don’t see any facts in your rant. You sound like another socialist looking for the government to solve your personal problems.

    The majority of people in this country, under 65, are covered by an employer sponsored health care plan and they don’t support you. So save your breath because a single payer system isn’t going to happen any time soon. With unemployment at 4.5% and falling employers are not likely to stop using healthcare as an employment incentive to attract the best and the brightest or at least someone to do the work. So most people will continue to be fat, dumb and happy with what they have. So much for your democracy rant.

    What we should be talking about is people taking personal responsibility and transparency in provider pricing among others things. If you want to improve healthcare and the cost let’s get all the players in the game. Are you over weight, do you smoke, do you drink to much alcohol and not get sufficient exercise. Most Americans who have poor health only have themselves to blame. This is a capitalist society and when we buy things the price is clearly marked, but not with healthcare. What will your single payer system do to address these problems? Do you see how fat Michael Moore is? I’m willing to bet he does some recreational drinking and perhaps he doesn’t have time to get much exercise.

    The insurance industry with their 4-5% profit margins, if they don’t make a bad call on risk assessment, is not the only one with blood on its hands. Putting politicians and bureaucrats in charge of this will just be one more step in the wrong direction.

    Let the market work. The government needs to take their oversight responsibilities seriously and force all the players in the game to be honest. I resent paying higher premiums for other people’s over indulgence, I want to know the true cost of the healthcare I buy, I want doctors to computerize patient records, I want chemical companies to clean up the ground water they have polluted and I want a real solutions not just something that is politically expedient for the next election so the masses think we are fixing the problem. If we continue to address the symptoms and don’t address all the underling problems we will just drive up taxes and reduce access to care for everyone.

    This is a complex problems and I have not heard one politician talking about finding a comprehensive solution. Part of the solution is tuff love. If you are over weight, drink too much, smoke and don’t get any exercise then don’t ask me to pay high taxes to keep you alive. If you are Michael Moore and have made a lot of money playing on the ignorance of the masses then you can afford to pay what it takes to keep you alive. Put that in your pipe and smoke it Michael.

  3. […] States’ Health Care Reform Efforts Doomed to Fail? […]

  4. jacksmith said

    Insurance mandates are not universal health care. And politicians should stop calling it that. Nothing is Universal Health Care except “Single Payer Not For Profit Tax Supported Government Managed Health Care” (HR 676). Insurance mandates will be worse than what you have now. And what you have now is a complete, and total disgrace, and horror show. Insurance mandates will (require) you to buy insurance from the private insurance companies that have been ripping you off, and killing you by the thousands.

    The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. Contact with the American medical health care system is the #1 risk factor now for injury, disability, and premature DEATH in America. This fact is a catastrophic indictment of the entire US Health Care System.

    Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.

    This is an emergency. America is in a crisis. And more Americans have died from this health care crisis than have died in all the wars in US history.

    But the tide has turned. And the message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that “HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)” is the way to go. Like all the other developed countries have done. Americans want government managed, tax payer supported health care Now. Medicare for all. Like other developed countries have. And like older Americans have now. Accept no substitute.

    I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company’s that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don’t put up with that.

    Just look at what is already happening with Massachusetts insurance mandates. It’s a catastrophe. Financially, and medically for all the people of Massachusetts. And the private insurance companies just raised their rates by as much as 16%. And everyone has to pay now. It’s a slaughter.

    It’s NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).

    Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It’s the best way to go on health care. It’s the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago. See, and

    I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And increase momentum for HR 676 at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.

    Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don’t be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.

    There is no good reason HR 676 cannot be passed into law well before the coming elections. And SCHIP should have been passed by now. Even if it was for 3x the 35 billion congress ask for. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections. This is supposed to be a democracy. And well over the majority of Americans want tax payer supported single payer government managed health care for free for all Americans as a right. Many of the politicians will be soliciting your financial, and political support for the coming elections. Make sure you send a note telling them that you expect them to support HR 676 if they expect you to support them.

    Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.

    Keep fighting. Pickup that phone, and call your fellow Americans. It’s the right thing to do. You will win. Bless you all…

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