At the National Governors Association meeting, Democrats and Republicans reaffirmed their commitment to a federal-state partnership in reforming health care.
At the meeting, President Clinton outlined a comprehensive program based on national standards but carried out and designed by the states. His approach recognizes that leadership must come from Washington and that innovation must come from the states.Yet critics of the administration's proposal have characterized it as overlooking each state's particular needs and differences. Such opinions are uninformed.
As a physician and governor of a state that is experimenting with health reform, I too want to be sure that reform handles the federal-state relationship carefully.
There is no doubt that President Clinton is doing exactly that: crafting a plan that will accomplish reform by creating a federal frame-work and then letting states tailor the approach.
The president has unequivocally stated that the government must not be in the position of micro-managing from on high what happens in the states.
From the beginning, the administration has made a huge effort to bring governors of both parties, as well as state legislators and their staffs, into the process.
The first meeting the president held on health care after his inauguration was with a bipartisan group of governors. At that meeting, which I attended, he showed his understanding of our concerns and supported our efforts to bring costs under control.
The concerns of state governments - especially the rising cost of Medicaid and Medicare and the hundreds of thousands of people losing their insurance each month - will be reflected in the administration's plan.
It will guarantee a comprehensive package of benefits, establish ways to pay for health care, outlaw unfair insurance practices, like excluding people for pre-existing conditions, and set national standards for medical quality.
And then the federal government will get out of the way. The states can then meet the national standards in the way that best suits their residents' needs.
In a small state like Vermont we would likely create a single health alliance to collect premiums from employers and employees and subsidize coverage for the poor. It would offer consumers a choice of plans and keep costs down by setting per capita limits on payments. Larger states would probably have more than one alliance, and may rely on competition between them rather than require per capita limits to keep costs down.
The federal government will set a date by which states would have to meet the national standards and design their own plans. Ideally, this would cause minimal disruption in the way Americans get their health care.
No matter what the final details of the federal plan are, consumers would have a choice of health plans, would be able to choose their own doctors and would have the peace of mind of an overriding guarantee: They would never lose their insurance again, whatever should happen to them.
In all of this, it is important to remember who Clinton is and where he came from. As governor of Arkansas, he suffered through the Medicaid increases of the 1980s. He saw health costs undermine other needs like education, children's services and police protection. Since becoming president, he has opened the White House door for the nation's governors more eagerly than any of his predecessors.
As the administration and the states debate health-care reform, we must keep alive the cooperation, the commitment to state flexibility and the spirit of bi-par-tisan-ship that marked our meeting in Tulsa.
Howard Dean, a Democrat, is governor of Vermont.