David Singleton’s comments:

“Which will be healthier in 10 years: Us or the Health Care System?” 

I will focus entirely on the second issue, drawing from my experience as a state secretary of finance.  I will cover the wide range of programs typically financed (in whole or in part) by states and counties, which can typically provide coverage to 1/3 or more of the residents of a state.  Most people are surprised to learn the extent of publicly funded healthcare – Medicaid, CHIP, public employees, public retirees, public hospitals, prisoners, etc.  These programs have grown rapidly in both participation levels and cost of care. Since these are largely entitlement programs, it has proven difficult to manage costs. And given the aversion to increasing taxes, this has resulted in a crowding out of other public sector programs, particularly education.  States are on their way to becoming “insurance companies with a police force”.  I will also touch on some of the things that we’ve done to try to manage costs…some fairly painless (generic drugs mandatory) and some more painful (increased premiums and co-pays for public employee health benefits).