Back in mid-August I had what is now beginning to look like a potentially prescient moment. It was then that I suggested that a politically feasible way to move towards a public option was to let the states decide to participate in the offering of such a plan or not. As I asserted at the time, such a strategy would turn one particularly large federal government target into fifty smaller state government targets. The use of states as policy laboratories is a wonderful benefit of our federalist system. It worked for Medicaid, and I believe it would work for the public option.
So does Sen. Tom Carper of Delaware, but he takes the option to another level, by letting states decide to opt for a public option, co-ops, or a state employee benefit expansion. I really think one of his staffers has been reading my blog. Okay, not really, but I like his idea so much that I would like to think that he got it from me. In an interview with Ezra Klein, Carper makes some excellent points, and it’s clear that he understands both the need for reform and the political hurdles such reform faces.
Jonathan Cohn’s on this story as well, and he provides an excellent summary of how Carper’s proposed amendment would work. He also questions whether Sen. Wyden has already beaten Carper to the punch with his own version of a similar amendment to encourage “state level experimentation.”
For what it’s worth, I continue to embrace the idea that states should be involved in health care reform. In fact, I think that local communities need to be involved. There needs to be room to tailor the system to the needs of real people. At the same time, we must not fragment the system any more than it already is. That means having national coordination overseen at the federal level, and the best way to do that is through the much-discussed insurance exchange. Cohn writes about that, too, and makes it very clear just how important the exchange is. In fact, how well health reform works to achieve the goals of increased coverage and cost-control is tied directly to the nature of the exchange–the stronger it is, the stronger our American health care system will be.