So says some extremely interesting and timely articles released in Health Affairs today.  See the press release for a summary and access to the actual articles for an interesting read about how using private sector-like models with only local intiatives is like spitting on a forest fire.
The conservatives want healthcare to follow a market oriented, private sector model, and the American health care system is in a death spiral because of this in relation to access, quality, and cost.  The implications from these important and timely studies, IMO, is that a new all-inclusive paradigm run by states or the feds will be needed to make any real difference. Hopefully if progressive ideas ever become in vogue again, we can learn from all these relatively failed local solutions.  Health care really is different than other insurance-based risks and other market amenable commodities, and the sooner we as a society realize this, the sooner we can start working on real solutions instead of fiddling around while Rome (I mean America) burns!

Excerpts from the press release:

Impact Of Community Initiatives On The Uninsured Limited By Economic and Political Obstacles

Bethesda, MD — Those hoping that community-level initiatives can make significant inroads into the problem of the uninsured may be in for a disappointment. That verdict emerges from a package of five papers published today on the Health Affairs Web site.

By examining many recent community initiatives, the papers demonstrate the creativity and diligence of community officials in seeking to improve care and expand coverage for the uninsured. But the package also illustrates the political, financial, and organizational obstacles communities face in this area, especially when they seek to expand coverage.

Reliance on private sector limits scope

A similar message is conveyed in “Community Approaches to Providing Care for the Uninsured,” based on research conducted as part of the Center for Studying Health System Change’s (HSC’s) Community Tracking Study, a longitudinal study of 12 health care markets conducted every two to two and one-half years. Community-based programs “are often invaluable to those who are able to enroll,” but they tend to “serve only a small proportion of their community’s uninsured residents, barely making a dent in the overall problem,” according to the study by Erin Fries Taylor, a researcher at Mathematica and an HSC consulting researcher, HSC senior researcher Peter Cunningham, and HSC research assistant Kelly McKenzie.

The difficulties that local leaders face are the same as those that hinder progress at the federal level: money and politics. “Community programs in the CTS sites increasingly are clustered around private-sector strategies, likely because public resources targeted specifically to programs for the uninsured have become more constrained in recent years,” Taylor, Cunningham, and McKenzie note. “Greater reliance on the private sector seems to be limiting the scope of these programs in terms of the number of uninsured people served, compared with the managed care programs of the 1990s that could tap into substantial public funds and pursue ambitious enrollment goals.”

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