MANAGED CARE December 2002. ©MediMedia USA
If all politics is local, the Institute of Medicine's recent recommendation that the federal government encourage the states to serve as laboratories for health care is a wise one. There's no reason to think that good ideas can't or won't come from the states; they are ideal testing grounds for new concepts.
The report, "Fostering Rapid Advances in Health Care: Learning from System Demonstrations [1]," covers in detail many of the failings of the present system and describes programs that could or should be undertaken to address many of the issues. I can think of no other undertaking that has tried to categorize our troubles and propose a way out of them, and it seems that a well-crafted effort to have states conduct demonstration projects has some chance of producing useful prototypes for other states and the federal government.
In case you hadn't noticed, this is a program that makes particular sense to the majority of those who are mistrustful of big government and who think the best decisions are made close to home. Having covered local and state governments in a previous career, I am not of that persuasion. Still, the IOM's plan, including chronic care demonstrations in a dozen communities, health insurance coverage experiments in 3 to 5 states, and information and communications technology programs in 8 to 10 states, has appeal.
These programs need to get going as soon as we can make them happen, and they have to be adequately funded — which means the feds. The states, as we are coming to know, are just about bankrupt and cannot run deep deficits the way that the national government has during most of our lives.
We are facing major problems of safety, cost, access and effectivness. I only hope that our health care system doesn't collapse before we get some usable results.