All that aside, I'd like to propose a dramatic health care reform plan of my own -- an eRevolution-style reform that, while radical, might be just what the doctor ordered (or what he would order, if the government wasn't regulating his business).
A Little Background
We're used to thinking of the government chain of command running from top to bottom: the Federal government is where the real power is, and the States take care of the leftovers and the little stuff. The Founders envisioned America differently: the States were sovereign government bodies (which derived their power from their own people), and these State governments, for mutual protection in trade, law and military matters, bound themselves together via the Constitution.
The Constitution, then, served as the contract between the States - not to overrule them, but to link them together in the common defense of liberty. Our Founding Fathers were so committed to this concept that they drafted the 10th Amendment to spell it out clearly: the powers not specifically granted to the Federal government in the Constitution were to be reserved for the State governments, or simply to the people themselves (private industry, charity, local governments, etc.).
With this arrangement, the day to day talk of the nation wouldn't be focused on Washington D.C., but rather on what was happening in the State capitols. The real power then, was much closer to home. And this worked to the advantage of the common man - he is far "closer" to the decision-makers at the State level than those at the Federal level.
(Prime example: I recently met with a State representative from my own area of Ohio, to talk about things happening in Columbus. We enjoyed lunch at a local Bob Evans. Unless I was "somebody important," this would be far more difficult to arrange with my federal representatives.)
The "closer" I am to the people making decisions as my representatives, the more influence I can have. But the more "federal" things get, the less empowered I am as an individual citizen, and the less "voice" I really have.
So, the Founders vision of the nation involved the power being spread around to the States, not centralized in one all-powerful Washington entity. The benefits to this arrangement are numerous; not the least of which is some healthy competition between States. If one State enacts laws or starts programs that are unfavorable, people can move to another State. But if the Feds do something you don't like, where can you go, realistically? (So for me, if Ohio raised taxes too much, I might consider moving to Florida, or visa-versa. That pressure to please the population should keep each state government from going off the deep end.)
You can read the Federalist papers for more on that, particularly #45 by James Madison.
The Constitutional Option
For health care, then, the Constitutional option would be to hand all medical programs over to the State governments and private industries or charities - precisely the opposite of the federal "public option" being discussed. Here are some specifics:
1. Spin Medicare and other government health care initiatives off to the State governments, working out a transitional budget wherein States begin to collect Medicare taxes and write Medicare regulations. Obviously, for years the Feds have been receiving Medicare income, and there will be a time of transition where the Federal government will need to proportionally direct money to the States and guarantee the fulfillment of promises made by federal Medicare thus far. But within a few decades, I think the transition could be complete (and the benefits would be felt almost immediately).
Benefits:
a) State governments know how to care for their people better than Washington bureaucrats - things that work in one part of the country may not work so well in others. (A liberal code-word we might use here: localism.)
b) People will have more of a voice in decision-making, because they are "closer" to the decision-makers.
c) Corruption and waste would be reduced because of the increased accountability at the State level.
d) There would be constant innovation and competition among States to provide better, more efficient Medicare/related safety net services. States that succeed would then be able to share good ideas with other States, and plans that fail can be avoided by others. This would likely result in better care at lower costs, and that difference would be felt throughout the system. Examples: one State might try a "public option," while another tries private incentives and health savings accounts, another goes with the health insurance "mandate," one State may get completely out of the health-care business and contract with private companies to do the work, etc. The best ideas win, the bad ideas lose, and overall health, prosperity, and customer choice are improved.
e) This brings our government in line with the 10th Amendment, restoring our right to a federal government limited by its Constitution.
2. Make a federal law that prohibits States from "exclusive" health insurance laws. In other words, people should be allowed to purchase their private health insurance from any company located in any State, just like you can purchase cars, books, stocks, or oil changes from any business anywhere.
Benefits:
a) A whole new world of competition in the private sector, which will result in better customer service, lower costs, and better incentives. More choices and equal opportunities for all.
b) Pressure on State governments not to place too many regulations or taxes on insurance companies and care providers within their State (since that would risk pushing those businesses to more "friendly" states).
That's it! Radical transformation 1790's style. Give it some thought, and let me know what you think. What are the potential blessings of the Constitutional option, and what might be some downfalls?
Disclaimer: I don't claim to know all the in's and out's of what this could mean. But as a student of the Constitution, I feel like we need to "reset" to our founding principles rather than continue on our current path.
Comments