In his speech to Congress, President Obama stated unequivocally: “Let there be no doubt, health care reform cannot wait, it must not wait, and it will not wait another year.” So should states sit on the sidelines and wait for the federal government to act? Absolutely not. Successful health care reform will require action in the states in tandem with progress in Washington. This is true even if national proposals succeed exactly as they are written, which is far from a foregone conclusion.

Immediate action in the states is especially critical in the area of making health care affordable for everyone.  Since current federal proposals are designed to build upon and strengthen Medicaid, Medicare, and the employer-sponsored healthcare system, they will only gradually alter the way that healthcare is financed and delivered in the United States. Thus, the states and their health care stakeholder communities still have a critical role in reining in the spiraling health care costs of our patchwork non-system of care.

Fortunately, stakeholders and policymakers out in the states are working actively to develop strategies to efficiently use medical resources in ways that improve quality of care. Here in California, San Ramon-based Hill Physicians is among those who have pioneered the use of pay-for-performance, electronic medical records and clinical effectiveness data to reduce costs and improve quality. The Pacific Business Group on Health is developing an innovative system to gauge the value of physician-provided healthcare. Insurers and corporations have instituted programs that improve preventive care and promote wellness. And Kaiser Permanente—which was founded and has its largest presence in California—is perennially years ahead of the curve, constantly improving a coordinated system of care which is both affordable and state-of-the-art.

There is much more that we can and must do. For instance, California could increase funding for programs that support primary care physician education. Case oversight by primary-care physicians can help avoid costly errors born of a system in which the chronically ill are treated by an array of poorly-networked specialists. Since care for people with chronic diseases accounts for more than 75 percent of all medical spending, California would also benefit from using the leverage of state programs to institute best practices in the treatment of diseases such as congestive heart failure, asthma, depression and diabetes.  The California HealthCare Foundation, for instance, is working to build a better chronic care infrastructure for the Central Valley where many diabetics have been found to have "no usual source of care."

The push for national health reform actually increases the importance of these state efforts rather than rendering them unnecessary. The lessons learned in ongoing efforts in states like California will inform policymakers in Washington as they discuss how best to expand access and improve quality while controlling healthcare costs. We cannot wait until healthcare reform is resolved at the national level before we decide how to act on the state level. To paraphrase one of Obama’s famous lines from his presidential campaign, “we in the states are the healthcare reformers we have been waiting for.”