Well, it's still a federal system . . .

Even though the federal government is abandoning public health and health care (and I'll have more to say later today, I hope, about that), and the same racists and religious fanatics who used to holler the loudest about states' rights are doing everything they can to override state policies they don't like now that they are in control of the federal government (viz. affirmative action in state colleges, physician-assisted suicide in Oregon, Terri Schiavo, medical marijuana, gun control . . .) the United States is still just that, and states can make their own policies.

Our old friend Fouad Pervez along with Sharon Silow-Caroll has rounded up interesting state news for the Commonwealth Fund. Check it out, but I'll just highlight Michigan's effort to address health care disparities. (That's the unequal treatment that people get who don't happen to be of the dominant culture and pigmentation.) They're doing a lot of the right things:

1. They have a committee to coordinate efforts to reduce disparities across disparate elements of the bureaucracy.
   
2. They provide funding to community based organizations to address health conditions within specific ethnic groups.
   
3. They require Managed Care Organizations to undertake specific initiatives to reduce disparities.
   
4. (Wonk Alert!) They analyze Health Plan Employer Data and Information Set (HEDIS)* data across racial categories.

There are problems with data quality -- the state Medicaid director says "a regular and standardized method for collection of data by race and ethnicity does not exist." This is a problem everywhere, and it is complex both conceptually and practically. But it needs to be worked on, hard, because we can't fix problems if we can't identify and measure them, and prove that solutions work (or don't). So

Hail! to the victors valiant
Hail! to the conqu'ring heroes
Hail! Hail! to Michigan
The leaders and best!
Hail! to the victors valiant
Hail! to the conqu'ring heroes
Hail! Hail! to Michigan,
The champions of the West!

*HEDIS is the standard data about processes of care that is used to assess the quality of care provided by hospitals, nursing homes, and health plans, as promulgated by the National Committee for Quality Assurance. It's used for accreditation, quality scores, and by state insurance regulators. Most states don't require that it be collected by race and ethnicity, which really sets us back in trying to fix the discrimination and inequality that still exists in our health care system.