Let 1000 Flowers Wilt: The Futility of State-Level Health Care Reform

Aside from the separation of powers, the genius of the American political system is its federalist structure which allows states to experiment with differing social policies. But the political system has failed in its reliance on states to reform a severely broken health care system. Continued reliance on states to correct the inherent flaws in the nation's health care delivery system is like the oft-repeated description of second marriages: they reflect the triumph of hope over experience. Likewise, state-based reforms reflect a resignation that no federal reform is likely any time soon, rather than a realistic hope that state efforts are likely to succeed. Despite the accolades accorded to the most recent health reform effort in Massachusetts, it, too, is destined to fail. The odds may be better than establishing democracy in Iraq, but not by much. Nothing in previous state-based health reform experiments predicts that anything short of a national overhaul can succeed. Some problems are perennial to every state and their health system, including rising costs, a growing number of uninsured and underinsured populations, troubled Medicaid budgets, and persistent federal inaction. Despite these obvious barriers, states have been desperate to expand health insurance coverage. Governors around the country think to themselves, "why can't we do that," 1 and since the 1970s, states have designed a wide variety of plans