Posted by
eRevolution.us on Friday, October 02, 2009 12:00:00 PM
Health Reform: The Constitutional Option
Daniel Jarvis (www.eRevolution.us)
Much has been made of the "public option" that
seems unable to die in the current health care reform debate. I hesitate
in using the word "reform" however, because usually reforms
involve changing direction, rather than accelerating the pace
of the current direction. The goverment role in health care, and the
"public options" already in existence, have been growing
exponentially throughout my lifetime (Medicare, federally-subsidized state
Medicaid, SCHIP, etc.), and from what I understand, are on the path to
bankruptcy, endless deficits, and overall gloom.
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.