It was a mistake to federalize health care
Tuesday, December 31, 2013 2:11 AM
President Obama would now like Americans to turn their gaze away from the spectacularly botched launch of the health insurance exchange website and look to all the people helped by the health care law. "Our poor execution in the first couple months on the website," explains Obama, "clouded the fact that there are a whole bunch of people who stand to benefit."
But, as America is now learning, many more people are being harmed by the law. Millions are already experiencing insurance policy cancellations, steep premium increases, the loss of employer-sponsored coverage, fewer health plan choices, narrower doctor networks, fewer work hours and even job losses. President Obama never mentioned these people during his recent White House speech.
Asking America to start thinking beyond website misfires is reasonable enough. Though, instead of just dwelling on the benefits, we would all be wise to take a fresh look at the totality of the law - warts and rainbows and all. The website can and likely will be fixed, but what about the law itself? Will it deliver a better health care system for most Americans? If it won't, what is the alternative?
The rollout reveals the truth behind Obamacare. The federal government now controls your health plan. Despite assurances to the contrary, federal regulations caused the cancellation of millions of health plans, and millions more will see their plans canceled or fundamentally changed next year. The federal government also took over key insurance regulations, which must be properly administered to keep state health insurance markets stable. State regulator hands are now tied if insurance markets begin to turn wobbly.
Proponents of the law will admit health plans are changing under tighter federal control, but they argue all of these changes are for the better. People, they say, are getting better health plans and better regulatory protections under federal control.
Does the federal government really know better?
Let's review some decisions. The federal government decided higher insurance premiums are an acceptable tradeoff for people paying less out of pocket when they see a doctor. The federal government decided to wager that most people won't wait until they get sick to get coverage even though insurers are required to guarantee coverage to all comers. The federal government decided the young should pay higher premiums to subsidize the old. The federal government decided low-income people are better off on Medicaid versus private coverage. The federal government decided to require employers to offer coverage, knowing some employers would need to cut hours or jobs to comply. And the federal government decided states cannot experiment with different ways to cover people with pre-existing conditions.
In our view, the federal government made the wrong decision in each case. Others may take a different view. The point in offering the list is to ask whether these are the sorts of decisions the federal government is best positioned to make.
We believe states - and individuals - are much better positioned to address these close-to-home issues. State lawmakers (and regulators) are far more accessible and able to change course if problems surface.
Federalizing health care necessarily wraps it into the ongoing national political drama. Special interests and politics have dictated nearly every major Obamacare decision to date. A health care system constantly embroiled in national political battles cannot deliver better health care.
The problems Obamacare aims to cure are real. Some people with pre-existing conditions have been unfairly denied coverage, and too many people struggle to afford the rising cost of health care. Moreover, markets for health coverage are not competitive, meaning there is very little consumer pressure to innovate and contain costs. Further, many of us feel tied to jobs just to keep our health care.
A more state-driven approach can deliver the same benefits Obamacare delivers and, unlike Obamacare, promote a more stable, competitive insurance market without upending the entire health care system (and with much less political drama).
Given the flexibility, states can design better approaches to connect low-income households to meaningful health coverage, cover people with pre-existing conditions without undermining the stability of the insurance market and promote more competitive insurance markets. The best part is that any difficulties or failures states face provide every other state with a powerful lesson.
Perhaps now more of us can see it was a mistake to "federalize" the challenges of health care in the modern era. Most of us agree the status quo was not working well, but Obamacare is forcing Minnesota from a system that was working better than most into an uncertain future. Wouldn't it be better if Minnesotans were in the driver's seat?
Kim Crockett is chief operating officer and Peter J. Nelson director of public policy at the Center of the American Experiment, a think tank that brings conservative and free-market ideas to bear on state and nation.