Healthcare, state by state

FED UP WITH WASHINGTON’S endless dithering on healthcare, some states are proceeding with reforms of their own. They’re convinced they can -- one by one if necessary -- find a way to cover more of the uninsured and mend the healthcare system from the ground up. They may succeed in increasing coverage, at least temporarily, but it’s unlikely that states alone will be able to repair the U.S. healthcare system.

Last month, Vermont became the second state in as many months to pass a universal healthcare measure. Starting this fall, it will guarantee low-cost health insurance for nearly all of its residents. By next summer, all Massachusetts residents will have to have health insurance -- just as they must have insurance for their cars -- and the state will offer subsidies to those who can’t afford it. True, both states are small, but several other states, including California, are considering similar plans.

It’s understandable that so many states are trying to take care of their uninsured residents. But not even a state the size of California has enough scale or influence to affect some of the afflictions bedeviling the healthcare industry, such as spiraling costs and unreliable quality. Without such leverage, states that are able to string together a universal coverage plan this year won’t be able to afford it for long unless they find a way to start printing greenbacks.

In 2003, Maine passed a law that significantly expanded insurance coverage by combining employer payments with expanded government programs. But the plan has not lived up to expectations. The state hoped to sign up 30,000 people by the end of 2005, but only 10,000 have joined because premiums for the subsidized health plan are still too expensive for most individuals and small businesses.

This helps to explain why the real solution to the nation’s healthcare problems will have to come from a Washington ZIP Code. If it’s smart, Congress will study some of the states’ innovative ideas to determine whether they could work on a national level.

Requiring all citizens to have health insurance, for instance, is an interesting idea that could gain bipartisan traction. Of course, subsidies for those who can’t afford the insurance would be costly -- but probably not as expensive as treating the uninsured in the nation’s emergency rooms.