Health care reform is happening in the states

By Christopher Atchison

Because the election of Scott Brown is now casting Massachusetts as a bellwether for the nation, it is appropriate to revisit the historical observation that states fill the role of what U.S. Supreme Court Justice Louis Brandeis characterized as “laboratories of democracy.”

In the Brandeis' view, states serve the very critical role of helping the nation work through important but complex ideas. One of the most critical and complex issues now facing the U.S. Congress is reforming health care.

National debates often distract for what is occurring at the state and local levels. This phenomenon can be observed in the analysis of the Massachusetts vote and its effect on whether the nation will achieve health reform or not. Overlooked in this analysis is the fact that the states have been working to address the entire dimensions of health reform and develop the strategies that can assure not just coverage, but access to and quality of health care as well.

Congress has demonstrated the complexity of the topic and clearly has not achieved an acceptable solution.

Though no state can claim to have completed the reform agenda, Massachusetts also demonstrates that bipartisan support for health reform can be achieved. Moreover, Massachusetts is hardly alone in advancing what should be recognized as a state-based but nationwide health reform movement. The National Academy of State Health Policy recently profiled nine states that have undertaken significant health reform efforts.

This list includes Iowa, which in 2008 passed one of the most comprehensive packages of health reform in the nation, including the expansion of child health coverage, the development of more patient-centered care and improvements in our state's health information systems. These are all elements of reform Congress purports to favor and yet unlike in Congress, Iowa's legislation was developed in a bipartisan fashion and overwhelmingly adopted by the Legislature.

An earlier member of Congress from Massachusetts, the late Speaker Thomas P. (Tip) O'Neill, is famously quoted as saying, “All politics is local.” There is nothing more local or personal than health care. While reform has generated a national political firestorm, it remains a topic that the vast majority of people, on both sides of the aisle, agree needs to be addressed.

We must not lose sight of, and must in fact encourage, the work of states to explore, propose and implement the aspects of reform that will produce the kind of system we all desire.

Christopher Atchison is director of the University of Iowa Hygienic Laboratory and associate dean at the UI College of Public Health.