Think Globally, Act Locally

And now a final thought from Yours Truly:

It was the spring of 1993, Washington's famous cherry blossoms were in full flower and change was in the air.

I was at the White House. Bill Clinton, in office less than a week, announced the formation of a Task Force on National Health Reform. Its goal was to prepare health-care reform legislation to be sent to Congress within 100 days. Clinton's wife, Hillary Rodham Clinton, would head the task force, sending a strong signal that if anyone wanted to mess with the initiative they'd have to mess with the president.

My editors had told me that I was to cover the reform initiative fulltime. I was excited. History was about to be made, and I was already well into the massive briefing book I'd been given as the Amtrak train hurtled up the Northeast Corridor to Philadelphia that evening.

A SPECTACULAR CRASH AND BURN

One hundred days later, the reform initiative and it's centerpiece -- health care for all Americans -- were dead on arrival.

The imperious Mrs. Clinton and her task force had committed a cardinal sin by working behind closed doors. Vice President Cheyney and his Energy Task Force would do the same thing a decade later, but Congress was not as forgiving of the outsider First Lady as they would be of the veteran insider veep.

But that was not the primary reason for this spectacular crash and burn.

While many Americans endorsed universal health care, Congress and the powerful health insurance and pharmaceutical lobbies to which they were beholden were adamantly against it, and they were the tail wagging this particular dog.

Fast forward 13 years.

Universal coverage remains the solution of choice for dealing with America's health-care ills, but stands even less chance than it did in those heady days when the Clintons were going to shake up the Washington establishment.

There are two primary reasons:

The devil's deal between Congress and the health-care lobbies is even more insidious. It matters not whether Republicans, Democrats or Little Green Men From Mars control Capitol Hill. The tail is still wagging the dog and universal coverage is still a non starter.

Health care has become increasingly balkanized. This is in part because of market forces and in part because it is becoming even more profit driven. Fewer corporations own more hospitals. Fewer health insurance companies cover more Americans. Fewer pharmaceutical companies control the market, stiffling innovation in new antibiotics, for example, while spending extraordinary sums on erecticle dysfunction medications.

THE MASSACHUSETTS WAY

What then to do?

Pardon the cliche, but the only way to begin to solve America's health-care woes is to think globally and act locally.

The burghers of Massachusetts are showing the way in creating a trailblazing system of near-universal coverage that will be phased in beginning next year.

Under the plan, all state residents will be required to take responsibility for their own health insurance and all companies with 11 or more employees will be required to help pay for health insurance. Low-income residents, of which some 200,000 are currently uninsured, will be eligible for substantial state subsidies.

The plan takes a carrrot-and-stick approach. Insurance will become easier and cheaper to purchase, but beginning in 2008, uninsured residents will have to pay a hefty penalty if they fail to fall into line.

What accounts for this lightning strike?

First and foremost, Democrats and Republicans alike checked their egos and heeded calls by Republican Gov. Mitt Romney and Democratic U.S. Sen. Teddy Kennedy to do the deed.

There were other factors as well.

Curiously, a federal government that has been deaf to universal coverage threatened to cut nearly $400 million in aid if the number of uninsured Massachusetts residents was not reduced, while a coalition of advocates, including religious leaders, had gathered enough signatures to approve a ballot measure more liberal than the bill passed by the legislature that was likely to be approved by voters.

1 DOWN, 49 TO GO

The Massachusetts plan is very much a work in progress. It undoubtedly has flaws. But it is a start, and there is great appeal to the provisions that require state residents to take responsibility for their own health-care coverage with the state taking responsibility for the people who can't afford that coverage.

Now that lightning has struck in Massachusetts, can it happen elsewhere? There are indications that it can, especially in similarly forward looking states like California, which is the home of Kaiser Permanente, one of the largest non-government health-care providers in the U.S. and an innovator in preventive care.

But the for-profit corporations that are balkanizing health care have powerful voices and deep pockets. What's good for Massachusetts and could be good for California is not good for these players if it impacts their almighty bottom line.

So my suggestion is that Americans who truly want to fix the health-care mess forget about Uncle Sam bailing them out. The promised land is in Sacramento, Albany or Madison, not Washington.