In early 2009, I decided that my chair's initiative for the National Governors Association would center on improving our system of delivering healthcare to the American people.
We didn't know then whether Congress would pass a comprehensive reform bill and, if so, what it would include. What we did know was that the rapidly rising cost of healthcare was outstripping the ability of states to afford it. It was exacerbated by the recession and recovery, and by government's previous efforts to expand coverage during better fiscal times. The same pressures drive up the cost of insurance for public employees and retirees as well. Medicaid alone is approaching a quarter of the budget in many states and, because it's an entitlement, it squeezes out other essential programs, principally education, which is a similarly large expenditure.
Much of the national debate has been about coverage, specifically expanding Medicaid to larger segments of the population, but that can't be the only focus. If we simply add more Americans to the ranks of the insured, we'll make the system even more unsustainable. We need to find ways to bring costs down, regardless of how we pay for them. States have shown a lot of creativity, as laboratories of democracy, to design healthcare reform initiatives that suit the unique needs of the people they serve.