State-Level Reforms Are Unlikely in 2008

Published March 1, 2008

Most of the legislative action on health care in the past year has been in the states, and it will continue to be so in 2008, though we don’t expect a lot of achievements this year at the state level, either.

It is an election year, and increasingly when the politicians are facing elections, nothing else matters.

In fact, even-numbered years have become a legislative black hole, and increasingly that is spilling over into the odd-numbered years as well. Politicians have discovered they have no greater purpose than maintaining or increasing their personal political power.

It may be a blessing. If we could keep them permanently on the campaign trail they would have no time for legislating, and the Republic would be better for it.

The National Conference of State Legislatures (NCSL) does a good job tracking bills that have been introduced, most of which go nowhere. Their Health Reform Bills 2007 report lists the states that considered some kind of comprehensive reform legislation. Considering how much attention health reform has gotten, it is surprising bills were introduced in only 20 states, and most of these were measures that never had a chance of going anywhere.

North Carolina, for example, entertained a bill that would amend the state constitution to “recognize the right to health care.” Other bills wanted to establish state agencies to take over all health care financing for all residents.

Source: National Conference of State Legislatures,

Mandatory Reading About Mandates

I rarely agree with David Himmelstein and Steffie Woolhandler, the husband and wife team of doctors from Boston who run Physicians for a National Health Plan. So it was something of a shock to read a New York Times oped by them and discover I agreed with every word except the two concluding paragraphs.

They look at the history of mandatory insurance coverage at the state and federal levels, beginning with Nixon’s pay-or-play proposal in the early 1970s. They then discuss the 1988 Massachusetts effort, Oregon’s in 1989, and similar laws in Minnesota, Tennessee, Washington, and Vermont in 1992-1993. In every case the laws were enacted with grandiose promises but ended up making the conditions worse than before or were repealed or overturned in court before they could be implemented.

The article quotes Oregon Gov. Barbara Roberts as saying at the time, “Our dreams of providing effective and affordable health care to all Oregonians have come true,” and Tennessee Gov. Ned McWherter announcing, “Tennessee will cover at least 95 percent of its citizens.”

This should be mandatory reading for every advocate of mandatory coverage.

Himmelstein and Woolhandler’s preferred solution is single-payer health insurance. They ignore that such a system would make all the existing problems in health care financing much worse, and they seem to have blind faith that the same politicians who made a hash of earlier efforts will miraculously transform into enlightened leaders once they control the entire health care system.

Wrong. It is far better to put your faith in “the people” than in politicians. Government should get out of the way and let the people control their own money.

Source: “I Am Not a Health Reform,” The New York Times, December 15, 2007.

Maine Plan Flops

Maine has recently joined the growing list of states with failed reforms. A recent report sponsored by The Commonwealth Fund, Robert Wood Johnson Foundation, and Academy Health and conducted by the Mathematica research company presents a devastating examination of a program that was poorly conceived and doomed from the beginning.

After 20 months of operation, only 11,000 persons were enrolled in Maine’s DirigoChoice plan (of a total uninsured population of 136,000), and more than two-thirds of those had been already covered by insurance.

Of the small companies eligible to participate, only 2.5 percent actually did. The financing scheme (a “savings offset payment”) is impossible to measure or implement, and almost as many people (3,600) had disenrolled from the program as were newly insured by it.

Although the report is fairly comprehensive at 26 pages, nowhere does it mention the cost of the program to Maine’s taxpayers or the cost per newly enrolled person.

Source: “Health Reform in Maine: DirigoChoice,” Mathematica Policy Research:

Greg Scandlen ([email protected]) is president of Consumers for Health Care Choices, an advocacy group based in Hagerstown, Maryland.