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Innovation, States Rights, and the Best Health Care in the World

By Dr. Evan Saulino
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“I cannot help fearing that men may reach a point where they look on every new theory as a danger, every innovation as a toilsome trouble, every social advance as a first step toward revolution, and that they may absolutely refuse to move at all.”
-Alexis de Tocqueville

De Tocqueville, recent darling of the political Right, described the promise he saw in our young democracy in the early 1800s and coined the term American Exceptionalism.  He also seems to have forewarned of the recent national Republican legislative and political strategy – especially regarding health care reform.  

But I’ll jump on that bandwagon of American Exceptionalism with the Right Wing and argue that certainly when it comes to health care, we should be best in the world. 

The question is: how do we get there?

Unfortunately, as any sane person with health policy knowledge understands, the United States is clearly not #1 in health care now – although we are “exceptional” because we spend so much toget so little and still leave over 50 million Americans out in the cold without any insurance coverage at all.

The Affordable Care Act (ACA) is an attempt to move towards something better.

However, as I have acknowledged in my earlier posts, the law is not perfect and there are numerous ways things could be improved.

But ever since they lost their tooth-and-nail fight against the ACA, rather than work to improve it, opponents of health care reform have been vowing to repeal the new health care law while at the same time hoping for activist judges to declare the law unconstitutional by arguing both individual and states’ rights. 

But we cannot just go back to the status quo – that would be unacceptable.

Rather than being obstructionists and refusing to budge like The Zax, while the world’s economies and health care systems pass us by, the Right (and the Left) should recognize there is already room for compromise and state-level innovation built into the new health care law. 

Don’t Litigate, Innovate” – an interesting piece recently on the Kaiser Health News site – outlines how a provision of the ACA authored by Senator Ron Wyden (D-OR), could offer a way forward – particularly for Republicans but also for Democrats. 

States that don’t want to follow the new health care law can essentially “opt out” – if think they can do better than what the federal government mandates. 

Waivers would be granted if a state can ensure individuals get insurance coverage that is at least as comprehensive as that provided under the ACA, that the coverage is as affordable (i.e. cost-sharing and protections against out-of-pocket spending) as under the ACA, that as many people are covered as under the federal plan, and that the state waiver will not increase the Federal deficit.

Senator Wyden recently teamed up with Senator Scott Brown (R-MA) – the man who won the late Senator Ted Kennedy’s seat last January.  They are proposing to move up the date that waivers could first be granted from 2017 as currently set, to 2014 – the same year the majority of the provisions of the ACA go into effect. 

Since their experiment with liability reform failed, this could be great chance for Republicans – who control nearly all aspects of Texas state government – to show how their best health care ideas work to control costs and expand coverage in a state with relatively expensive care and thehighest levels of uninsured in the nation.  Alternatively, this also could be a chance for single payor advocates in Vermont or some other state to show how well their plan works on the state level. When one or two states figure out solutions that are proven to work, these strategies can be expanded nationally.

History shows us Americans can accomplish anything if we put our heads together – but blame and infighting get us nowhere. 

It’s time to show some leadership and stop the petty political games. 

If federal and state politicians across the nation can muster the leadership, cooperation, and pioneering spirit needed to go through the kind of “toilsome trouble” we have begun here in my state, Oregon, our nation will find solutions to our health care problems and demonstrate American Exceptionalism at its best.

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