On Deck for Healthcare Reform: Rhode Island

It was a swing-and-a-miss for California last month, when the Governor's plan for universal health coverage failed in the state senate. Now Rhode Island steps to the plate. Yesterday Lieutenant Governor Elizabeth Roberts brought before the Legislature a plan to expand coverage in that state. Significantly, she stopped short of using the word "universal."

That is because universal coverage is ungodly expensive. The politic term now is "near-universal," and even that may not fly. To help fund the program, Roberts recommends both an individual mandate and a penalty for businesses with uninsured employees, measures that inflame Republicans and Libertarians. And not just them--I present Tourette's-like symptoms whenever I hear the word "mandate."

To her credit, Roberts recognizes that changes need to be made in the way care is delivered to make it more affordable. In other words, cost control must come before universal enrollment. She recommends such strategies as emphasizing primary care over emergency care, managing treatment of people with chronic diseases, and paying doctors to keep patients healthier. Her proposal would also establish a massive database of healthcare treatments, outcomes, and costs to help evaluate the efficacy and cost-effectiveness of all the surgeries and medications thrown at us these days. Do they work, and do they work well enough to justify the expense?

The cost-control programs are modeled after Vermont's health-insurance initiative, which is in its second year. The only other states to adopt comprehensive healthcare programs are Maine and Massachusetts.