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The Dartmouth
June 23, 2024 | Latest Issue
The Dartmouth

Lane: Too Often Forgotten

States must pick up Congress’s slack by expanding health insurance programs.

State legislatures get the short end of the stick when it comes to news coverage. Most national newspapers and TV channels naturally have their eyes glued on Washington, D.C. rather than attempting to monitor all 50 state capitals scattered across the U.S. Regardless of how closely people are watching them, state capitals are endowed with great powers.

In light of the lack of progress on much of anything at the federal level, state governments must step up to the plate. An excellent avenue for them to do so is through healthcare reform. Our current healthcare system is quite simply broken — leaving millions without the care they need — and is ripe for a fresh policy approach. State-level single-payer health insurance programs are an especially bright option. By working on healthcare and utilizing their power for positive change, states could both inspire and uplift America in a time that all too often seems to be just one disappointment after another.

Working people in this country have already suffered enough during this dreadful pandemic. The last thing they need is to go back to the bleak non-system of healthcare that we’ve had for far too long. The CDC estimates that just under 15% of the U.S. population ages 18-64 — seniors are mostly covered under Medicare and children are mostly covered under their parents or the federal Children’s Health Insurance Program — has no health insurance at all. That statistic alone is atrocious, but it also leaves out those who may have insurance which doesn’t get them the care they need. According to the health insurance marketplace company eHealth, the average deductible for a family plan obtained through the ACA was around $8,400 in 2020. The median liquid net worth of Americans under age 35 is about $3,000 and about $8,000 for those between 35 and 44, so it’s not rocket science to see the peril that millions of insured Americans are in. A single emergency room visit due to an accident or illness completely out of their control could send them straight into bankruptcy. Is that the country we want to live in? Are we truly not capable of providing anything better for those who are suffering? I refuse to believe that we are so helpless.

Unfortunately, many states have been making poor use of their powers rather than addressing pressing issues like healthcare. Recently, Republican-controlled legislatures across the country have been busy churning out new laws that make their states look more like laboratories of authoritarianism than the “laboratories of democracy” that former Supreme Court Justice Louis Brandeis hoped for back in 1932. Georgia’s new voting restriction laws attracted a lawsuit from the Justice Department, Texas Democratic state legislators have fled to D.C. in a last-ditch attempt to stop the passage of a particularly egregious package of voting restrictions, and Florida is requiring that universities ask students and faculty about their political views and report them to the state — under the possible threat of funding cuts if the numbers don’t meet expectations for “viewpoint diversity.” None of these actions will help regular Americans make ends meet, much less get the healthcare they need. 12 states haven’t even expanded Medicaid under the ACA since it was passed over a decade ago.

Nationally, the healthcare debate is dominated by independent Vermont Sen. Bernie Sanders’ “Medicare for All” bill. In an ideal world, reform would occur through such a bill, because doing so nationally would leverage the benefits of massive economies of scale. However, the current tenuous political balance in Washington with a 50-50 senate makes it apparent that such reform won’t be happening before the next elections, if not later. The queasiness that many Democratic politicians have surrounding anything that hints at substantial change is both unfortunate and embarrassing. But, this is where the states can come in. State-level reforms, while less ideal than national ones, could serve as excellent case studies for how reform could work nationally in practice, and build momentum for national change in addition to getting help to those in need quickly.

There are currently a handful of states with bills seeking to create single-payer healthcare systems, including in my home state of Minnesota. A 2011 proposal passed in Vermont got the closest to enactment, although it was cancelled in 2014. While the most common refrain is that it failed because of concerns over raising taxes to pay for it, executive mismanagement more likely killed it because numerous studies using differing methodologies found it to be economically feasible. Vermont’s situation is no bright spot, but states should take it as a lesson on how to avoid implementation problems rather than discouragement.

Inevitably, states must decide how they intend to pay for expanding health care, either through the ideal solution of a universal health plan for all residents or some other sort of proposal. Opponents jump to counter that the money to do so simply isn’t available. Do not be deceived by these claims. A study published in the Lancet just last year found that nationally, a Medicare For All plan would result in 13% less national health care expenditures overall, even when factoring in the cost of covering the uninsured and getting adequate care to the underinsured. If the money “just isn’t there,” then we couldn’t be spending the absurd amounts we do today. It may be that states would see smaller drops in health care expenditures overall compared to the Lancet study since they can’t achieve the economies of scale that a national plan could, but nonetheless, large savings are clearly there for the taking.

The study also found that Medicare For All would save an estimated 68,000 lives each year, not to mention the millions more who would be able to live more dignified lives. Nonetheless, health insurance, pharmaceutical and hospital conglomerates have been fighting tooth and nail to preserve their profits. They are not afraid to mislead and lie in order to do so. Their yachts, vacation homes and investment portfolios depend on it. But despite what they may say, it’s our current system that is unaffordable, both in monetary terms and in terms of the human cost.

States have a lot of power. Too often that power is left to sit around and collect dust, or worse, it is used to bludgeon those who cannot fight back. It’s long past time for blue states to pick up their tools and get to work on healthcare, showing the rest of the country what good that can be accomplished when states set their minds to it. 

Thomas Lane

Thomas Lane '24 is a former Opinion editor.