Saturday, September 19, 2009

The Road to Universal Health Care Begins At the State

Speaking via ForaTV, TR Reid has a message for US President Barack Obama:

You're going about health care reform all wrong.

Reid uses the story of the evolution of Canadian health care as an example of how Obama should develop his own reforms.

As Reid notes, Canadian health care wasn't originally a child of the federal government -- it was a child of the Saskatchewan Provincial government of Tommy Douglas.

Beginning in Saskatchewan, Douglas' program was eventually implemented by the federal government.

Reid does make a few errors in his description of the evolution of Canadian health care. First off, doctors didn't flock from the other Provinces to Saskatchewan begause they "knew they'd get paid". Doctors flocked from other Provinces to Saskatchewan because doctors in Saskatchewan went on strike after Douglas introduced universal health care in that Province.

Nor did universal health care become implemented at the federal level because the other Provinces demanded it -- although the "demonstration effect" was almost certainly a factor. Rather, universal health care was implemented at the federal level because Lester Pearson needed Douglas' support to keep his minority government alive.

(Although Pearson dearly wanted a majority government, he never managed to secure one.)

Universal health care was implemented federally largely incrementally. Tommy Douglas can certainly take the lion's share of the credit, but policies instituted by Louis St Laurent, John Diefenbaker, Pierre Trudeau and Brian Mulroney (among many, many others) contributed to the slow evolution of Canadian health care into what it is today.

It started, however, with the successful implementation of the model in a single province. This is a lesson that US President Barack Obama should take to heart.

Instead of ramming a single 1000-page bill through both the House of Representatives and the Senate (a fool's errand in any case), Obama could instead make additional economic stimulus funds available to states that wish to implement their own form of health care reform.

As Reid notes, this could allow for something of a "policy laboratory" to emerge in various US States in order to find a package of reforms that works for the specific needs of the United States.

As TR Reid concludes, any governor that could plant that first seed of a successful health care reform program could some day be the United States' very own Tommy Douglas -- not only the father of universal health care, but perhaps even win a Greatest American poll someday.

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