A State by State Approach to Universal Health Care

Earlier this month we posted an entry about the efforts of SPAN Ohio to create universal health coverage in Ohio based on a single payor system. This effort joins efforts in other states to achieve universal health coverage in the absence of any effort by the Federal Government to achieve this goal. These efforts are usually presented by the media as being evidence of some sort of "failure" by the Federal Government. There is another way, however, to look at such efforts.

One of the problems with the Clinton health insurance plan of the 1990s was that it tried to impose one structure on all of America. Quite frankly, such an approach has a multitude of problems. This is a very large and diverse country. The states range widely in population, culture, and demographic make-up. A plan conceived in Washington to cover every state is bound to be resisted since there is no guarantee that such a plan will work in every state.

Here's a different approach: why not advocate a plan that uses the taxing power of the United States government to achieve this goal without mandating any particular plan? Here's how this would work: the United States government would reduce the income taxes for the residents of any state that reaches the goal of universal health coverage for all its residents. How the states get there is up to them. Whether they want to get there is up to them. The Federal Government would develop the yardstick and apply it to the states. It would also publish tax tables showing the states that are getting a break on their taxes.

What this would do is put pressure on state legislatures and governors to come up with universal coverage. It would be very hard for Republicans to oppose politically and it would stop liberals and Democrats from having to work out the detail of a plan while trying to win elections.

Is it a perfect solution? No, but that's not the choice. The choice is between the status quo which leaves an increasing number of Americans uninsured and a plan that increases the number of insured Americans.