I've spent much of the day considering the consequences of Sen. Obama's victory in the presidential election to health reform efforts in the states.  I regret to say that it does not look good.

I wrote an analysis of Sen. McCain's and Sen. Obama's health plans before the election.  Whatever health reform comes out of Washington in 2009 or later, Sen. Obama's proposal will only form one ingredient of the package.  (My guess is that he will build on the Wyden-Bennett bill.)

Nevertheless, his platform is very clear: he intends to take away communities' power to regulate the delivery of health care, by federalizing those parts that are exclusively or mostly under state control:

• He will prevent insurers from charging higher premiums for pre-existing conditions.  This means that people will wait until they get sick to buy health insurance, resulting in an impossible situation.
• Bizarrely (in that I've never heard it proposed before), he wants to regulate premiums that medical liability insurers charge physicians.  He appears to have misidentified profiteering liability insurers as the cause of high medical malpractice costs, rather than excessive tort payouts.
• He wants hospitals to report quality and cost data to the federal government.  Currently, there is some of this for Medicare, but it is not a general mandate.  This opens the door for a federal Certificate of Need program!

All three of these issues are elements in PRI's Index of Health Ownership, which measures how much freedom states give their residents to control their own health care.  Obviously, if the federal government seizes this power from states, the scope of individuals' health ownership will shrink significantly. 

While there are other major drawbacks to Sen. Obama's proposal, these are the ones that stand out as attacks on communities' freedom to regulate their own health care providers.