2 Years Of Reform Status Report: This Is Hard Work

The Commonwealth Fund released a brief this morning outlining the status of all 50 states on implementing 10 key provisions of reform. 

It said 49 states, plus the District of Columbia, had taken action to implement reform.  The one outlier was Arizona.

What I thought most interesting, and I guess shows my provincialism, is which states were identified as leading the way on implementation’s reform.  In this report, the 12 states that had taken action on all 10 of reform’s items were in the upper Midwest, the northeast, and the mid-Atlantic region.

On the one hand, this is reflection of the status of 10 central but still somewhat arbitrary reference points chosen by The Commonwealth Fund, like whether the state had implemented statute or regulations on recission, lifetime dollar maximums, etc.  One needs some standards by which to measure progress, and these 10 are probably among the best objective standards by which to measure.

On the other, it’s not so much a measure of which systems are “reforming” most quickly.  It doesn’t measure the thoughtfulness of reform efforts, or the commitment to improve the system for the state.  Oregon would have to be in that mix by almost any standard, but isn’t in the top 20% of states here.

So, what do we learn from the 12 page brief if there is some question about how well the indicators?  Probably a re-iteration of lessons we know but are worthy of repeating often.

1.  Every state is doing this differently, regardless of national reform efforts.

2.  It’s still hard to get good information shared across states, no matter how hard we try.

Not rocket science that, but it’s worth admitting to ourselves that this is hard work.  VERY hard work.  It’s going to take us a while to reform the system, and that’s ok.

Say it with me, group therapy colleagues:  “Reform is hard, and…”