By Evan Falchuk

At last week’s NBGH conference, I am told Senator Max Baucus made an interesting observation.   He said that America is not Germany or the UK or Canada, and so whatever kind of reform we create here must be “uniquely American.”   It’s an obvious point, but it highlights something important:

What does it mean to have a uniquely “American” healthcare system, and uniquely “American” healthcare reform?

Americans are enormously individualistic and our attitudes about healthcare reflect that.   We want healthcare to be more accessible, but we recoil at ideas of massive new spending or increased government involvement in our healthcare decisions.    We think our system is uncoordinated, expensive and in need of reform, but that our own coverage is just fine, thank you.  Americans are also tremendously creative, and when faced with a problem try to tackle it with an entrepreneurial zeal.   Indeed, the CBO recently summarized more than 100 reform proposals, and the President’s (awkwardly-named) Forum on Healthcare Reform brought together dozens of leaders and the work of thousands of reform advocates.

Americans are also very impatient – when we see a problem we want to fix it now.   Even as the federal government sorts out reform ideas, states are implementing their own healthcare reform programs.  Massachusetts is already in a new, second wave of reform to try to deal with the costs of its 2006 reforms.   In Utah, the governor signed into law last week a bill that would give employees the option to take the employer’s contribution to their health insurance coverage and buy their own coverage from a state-run web-site.   Overall, at least 17 states are considering or have adopted some sort of reform program tied to creating universal coverage, with numerous other reforms in the works elsewhere.   There can be little doubt that these diverse and continuing efforts across the country will complicate attempts at a unified, national approach to reform.

At the federal level, the government is going to have to figure out a way to balance the burst of creativity shown across the country with the political pressure to pass federal reform. Maybe this is what Senator Baucus means by a “uniquely American” approach to reform.