The obituaries are already rolling in. Given that they’ve been written at least five times before–and been wrong then–I’ll hold off.

People are starting to ask how this impacts the prospects of national reform.

If this succeeds, it’s a big boon, both to reform efforts in other states and nationally. If it fails, it certainly doesn’t help, but I am not so sure it hurts.

California has more obstacles than all other states, and perhaps

At the same time,

Let’s remember the context:

* National health reform is hard. Health care has an enormous number of stakeholders that are impacted by any change, and it’s hard to get a consensus, especially in a country so large and diverse, both in terms of the on-the-ground infrastructure, and in terms of ideology. On health care, Washington, DC has been polarized on any solution, which has resulted in gridlock.

* State reform is hard. In particular, there’s contraints in policy and process: Medicaid rules, ERISA, and the biggest of all, the ability to finance the system.

California has the size and diversity of reform, but

It’s important to remember: we’ve had a state legislature that has voted in the past five years for four different
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