President Obama recently seemed to endorse a proposal from Sens. Ron Wyden, D-Ore., and Scott Brown, R-Mass., to allow states the option of moving to universal coverage without a health insurance mandate. This came at an appearance before the nation's governors at their midwinter meeting in Washington.
Republican governors generally gave it the brush-off, as did GOP House leadership. Democrats appeared to be surprised.
One can't tell whether this is simply a 2012 campaign strategy developed by the White House with help from its new health reform strategist, Paul Tewes. Or the president may be signaling, again, his willingness to consider negotiating changes in the new law -- the Affordable Care Act, or ACA -- with congressional Republicans and their allies among the governors.
In any event, the proposal, as health coverage policy, is weak tea.
States can't do systemic reform and coverage expansion without massive doses of federal money. And it is irresponsible for the feds to dole out hundreds of millions without the assurance of insurance, payment and system reform, as well as universal coverage. That's the problem with Republican proposals to use a "block grant" approach in giving Medicaid dollars to the states to do with as they will. Massachusetts has already proven that.
Some Democrats responded to the president's speech by suggesting this would open the door to states considering single payer options for payment reform -- which, of course, it would. Vermont is already headed in that direction. Maine, when it has a Democratic governor, would be right behind. Eventually, were the ACA to be repealed or weakened, the inexorable rise in health care costs would force a lot more states to adopt single payer or "Medicare for All" approaches to coverage expansion.
President Obama gave the nation a once-in-a-lifetime chance to develop a uniquely American health care system in the passage of the ACA. It is an opportunity to capitalize on the strengths of the nation, on the proven advances in health care quality improvement and cost containment that exist in some regions of the country. Compared to other developed countries, this is very much a road less traveled. The president should use his precious time to encourage the law's implementation as soon as possible in areas of the country that are already on this road -- like our own Upper Midwest -- not to coddle his political enemies.
David Durenberger, former Republican U.S. senator from Minnesota, is senior health policy fellow at the University of St. Thomas and chairman of the National Institute of Health Policy.