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April 21, 1993

Can States Take the Lead in Health Care Reform?

JAMA. 1993;269(15):1942-1943. doi:10.1001/jama.1993.03500150050022

To the Editor.  —I read with interest the article "Can States Take the Lead in Health Care Reform?" by Moon and Holahan.1 They concede that "states can demonstrate new approaches and take important steps toward improving access and/or containing cost" but continue to the puzzling conclusion that "relying on states alone is unlikely to be the answer to the national problem." This betrays blind faith in an omniscient federal power to solve a problem where individual states have failed.This is the worst possible conclusion. In the effort to make a profit, entrepreneurs compete in the market. The consumer benefits from the smorgasbord of options and prices. Yet many say that health care is not subject to market forces and that the demand is "inelastic." This assumption is wrong, and the truth of the matter lies with three questions.First, "Is 'health care' a single community, or is it a