So did you hear the news. The Obama administration is going to let each state define what essential benefits are in health insurance coverage for 2014 and beyond  avoiding a Titanic federal lobbying battle between employer interests, health plans, health providers, pharma, and (God bless em) consumer advocates.

Apparently, this is the Obama administration's idea of a 50-state jobs program: for statehouse lobbyists. It's also an invitation for enemies of healthcare reform to assure its ultimate failure as a national healthcare coverage program.

What this means, in practical terms, is that governors and state legislatures across the country (including those who have sworn publicly to defeat Obamacare by any means) will decide who runs the state's healthcare exchange and who decides what does, and what does not, get covered in the health plans we're all required to have.

In the world of statehouse gun-for-hire, this is the bonanza of a lifetime. These professional influencers will all hire out to the various moneyed stakeholders: the local Blue plan, the national plans or a coalition of them, the local for-profit hospitals, the non-profit hospitals, the research/academic hospitals, physicians, specialist societies, pharma companies, PBMs, nurse-practitioners everybody who wants to make sure they've got a seat at the table when the big feast starts.

Then, in 2013, the lobbyists billable hours will really flow: plenty of hearings, meetings and behind-the-scenes pow-wows (much of it taking place outside of public view and decided by people who will not be accountable to voters in any way) to decide what the minimum standards for health coverage will be. Coverage taxpayers will be subsidizing, by the way.

We all know that state legislatures are bastions of deep thought and dazzling insight on matters of healthcare policy, actuarial soundness and the economics of healthcare delivery. Nevertheless, they listen to the lobbyists wisdom, adding it to their own. The happy result is that national healthcare reform, now becomes a mandate for all of us to purchase (directly or indirectly).what exactly

Will minimum drug coverage be $4 generics, plus Viagra. Will the exchange plans requirements promote or frustrate the national movement toward collaborative care. Will primary care be limited to three physician visits. Five will certain types of birth control be covered. Will there be limited access to specialty drugs. Do we really want these to be political decisions debated in the back-rooms of 50 statehouses. Do we really want a healthcare system that is balkanized in this way.

The only thing certain in this is that the next two years are going to be extremely profitable for the Gucci-shod glad-handers who prowl the halls of our states legislatures. I'm not sure anyone else will come out so well.

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