During this morning’s press conference, Senator-elect Scott Brown (R-MA) downplayed the importance of health care reform in yesterday’s special election and reiterated his support for leaving reform to the states. “While the health care bill was certainly an issue, the issues that were just referenced by your fellow journalists were issues that were in people’s minds,” Brown said. “You’re talking taxes and spending, terrorism and how we deal with those issues, the health care proposal, those are the more important things.”

Brown highlighted his support for Massachusetts’ 2006 health care reform bill and argued that his state may not benefit from the national effort:

We already have 98% of our people insured here. We know what we need to do to fix it, but to have the one-size-fits all plan that is being pushed nationally, it doesn’t work. So what I have suggested and what I’m hoping to suggest — because we’ve done it here, we have some experience I’ve voted for health care here so I care very deeply about it — is to let the states tell the federal government, ‘hey this is what we’d like to do. Can we work with you in a team effort, maybe you can incentivize us to do something better, model it like we have it or maybe come up with something better, so that we can learn.’

Watch it:

While Massachusetts adopted effective health care reforms, its success will not add up to a solution to the systemic problems plaguing American health care. As Brown himself points out, the lessons from one state tend to be just that—applicable to one but not the rest. State uninsured rates “vary from just under 8 percent to almost 25 percent and, generally, where those rates are the highest, the states have the least resources in terms of a tax base or population income levels to support funding for needed coverage expansions.” Balance budget requirements prevent many states from making meaningful long-term investments in reform and powerful health care industry lobbyists often stand in the way of reforms that could reduce industry profits.

In fact, just as Brown was suggesting “to let states tell the federal government” how they wish to reform the health care system, Kaiser News Service reported that budget woes were prompting states to cut back on existing health care programs:

- UTAH: “Utah’s Medicaid program isn’t providing enough oversight of its managed care plans, a problem that is costing the state as much as $19 million, according to a Legislative audit released Tuesday” (The Salt Lake Tribune, 1/19/2009)

- KENTUCKY: “Facing exploding growth in the government-run health insurance program for the poor and disabled, Gov. Steve Beshear’s proposed budget calls for spending an additional $782 million on Medicaid over the next two years.” However, Beshear is also calling for $108 million in cuts to the program over two years, and 2-percent nearly-across the board cuts to Cabinet for Health and Family Services programs (Lexington Herald-Leader, 1/20/2009)

- VERMONT: “Gov. Jim Douglas said Tuesday it would take $53 million in spending changes to human service programs affecting the elderly, children and the poor to close the gap between available revenues and expenditures next year” (The Burlington Free Press, 1/20/2009).

- NEW YORK: “Among the major provisions of [Gov. David] Paterson’s spending plan is a $1 billion reduction in state Medicaid spending. Paterson would achieve most of that savings by cutting Medicaid reimbursements to hospitals and nursing homes” (The (Elmira, N.Y.,) Star-Gazette, 1/19/2009).

States don’t have the economic, political or structural capacity to invest in something as big as health care reform and too many are already struggling to maintain their Medicaid programs in the face of enrollment increases. Political considerations, special interest influences and budgetary strains have doomed previous state-based health care reform efforts and exporting reform to the states is just another way of killing it.

While House Speaker Nancy Pelosi (D-CA) is insisting that Democrats “don’t (think) a state that already has health care should determine whether the rest of the country should,” several prominent Democrats are misinterpreting Senator-elect Scott Brown’s (R-MA) surprise victory in Massachusetts as a referendum on national health care reform and are urging Congressional leaders to slow down the process:

- Sen. Jim Webb (D-VA): “In many ways the campaign in Massachusetts became a referendum not only on health care reform…I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.”

- Sen. Evan Bayh (D-IN): “There’s going to be a tendency on the part of our people to be in denial about all this, [but] if you lose Massachusetts and that’s not a wake-up call, there’s no hope of waking up.” “Whenever you have just the furthest left elements of the Dem party attempting to impose their will on the rest of the country — that’s not going to work too well.”

- Rep. Barney Frank (D-MA): If Martha Coakley had won, I believe we could have worked out a reasonable compromise between the House and Senate health care bills…. But our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened.

- Rep. Anthony Weiner (D-NY): “It’s not the end of the world. Look, we can come back to healthcare.” “It wouldn’t be the worst thing in the world to step back and say, look, we’re going to pivot to do a jobs thing. We’re going to try to include some healthcare pieces in it.”

Public hostility towards health reform certainly helped propel Brown to victory, but as economist Austin Frakt explains, “[t]he real lesson seems to be less about policy and far more about politics.” After all, Brown doesn’t make a very convincing messenger for opposing the policy behind health reform. As a state senator, Brown voted for Massachusetts 2006′s reform law which, like the Senate and House bills, includes an individual health insurance mandate, insurance exchanges, government affordability credits and insurance regulations. As a result of the law, 98% of Massachusetts residents have health insurance and 79% want the law to continue. Unlike voters in more conservative states, Massachusetts residents don’t fear national reform because it would result in a government take over of health care — they’ve already benefited from the provisions in the Senate health care bill and they support them.

Brown’s campaign tapped into voter frustration with skyrocketing premiums (unlike the national bills, Massachusetts reform did not include cost containment) and the political sausage making process to cast the national reform as an unnecessary effort that could only increase costs for Massachusetts residents. “[W]hy do we need a one size fits all government approach we already did it?” Brown asked voters during a debate with Coakley. “[T]he Federal plan, taking a half trillion from Medicare, why would we go and subsidize the failure of other states – not only would we be paying for our plan, we’d be paying for everyone else – and look at the back door deals – I think people have lost confidence – and I think that we need to go back – I’d work on it,” he said. Brown localized the reform issue. He stripped it of its policy clothes and presented the effort as a hindrance to the state’s successful program. He promised to be the 41st vote against reform because Massachusetts had already passed its own health reform bill, arguing that the state shouldn’t pay for the national effort?

It’s unclear how many voters voted for Brown because of his opposition to the national health reform effort, but at least one poll suggests that enthusiasm for reform was greater than the movement against it. According to Rasmussen Reports election night poll, 63% of Coakley voters said health care was the most important issue in determining their vote, while 52% of Brown voters said it was their top issue.

Since national dissatisfaction with reform coincided with the Senate’s effort to water-down the bill, Democrats shouldn’t distill the legislation further or put it off altogether. “If the Democrats run for cover, if we become pale carbon copies of the opposition, we will lose–and deserve to lose,” Ted Kennedy once said. “The last thing this country needs is two Republican parties.”