But what about Massachusetts? They managed to pass health care reform, and though it is not perfect, it beats the heck out of what they have in Washington and Idaho, the states in which I practice medicine.
Just today I read an article in the New England Journal of Medicine about the way the medicaid system is administered in Oregon. They use cost effectiveness research to determine a basic health care package, and then budget to allow as many people as possible to be covered by the state Medicaid system. This is the article: http://content.nejm.org/cgi/content/full/362/7/e18
I would very much like to see Idaho, where we spend 20% of our state budget on health care, combine intelligent “rationing” with creative payment schemes (prepaid health care aimed at encouraging appropriate health care utilization) to extend coverage to state residents who can’t afford to pay for private insurance.
In fact I would very much like to see every state design location appropriate health care reform to take care of citizens who don’t have access. The huge crisis of medicare costs still needs to be dealt with at a federal level because medicare is a federal program and is much of the federal budget. Much of the house health care bill focused on making medicare more efficient and more effective. Reciprocity would also be an issue if health care reform was done by the states, but that is hardly a deal breaker.