Belmont Club

Changing the Way Things Are Run

Meanwhile, the Interstate Compact idea for reforming health care is growing larger. Eleven states are working to get it passed by their legislatures. Leo Linbeck III and Eric O’Keefe, writing in the National Review, argue that the states, not the Federal Government, should be in charge of health care. The main roadblock to improving government intervention in health care is that the key decisions are taken in Washington.

The Health Care Compact is a governance reform, not a health-care-policy reform. It would change who decides health-care policy, not who or what is covered. The Health Care Compact is needed because no centrally planned, top-down reform can fix health care throughout the United States.

Instead, each state should craft its health-care policies to fit its specific needs. Some states may choose a single-payer system, while others may opt for a health-savings-account system with subsidies for seniors and low-income residents. Under the Health Care Compact, each state decides which plan is best for its citizens. …

The Health Care Compact offers a choice to the president and Congress. They can continue their partisan bickering over federal health-care reform, or they can embrace an approach that is more likely to succeed, one that brings control closer to the people by putting states in charge of health-care dollars and policies.

The real dynamite lurking in the initiative is that it is not just about health care but about the distribution of power. One reason it has gathered so much state support so quickly is that the political arena’s “engagement queue” is saturated by so much: the union battles in Wisconsin, the budget hearings in Washington, the crisis in the Middle East — to simply name a few.

The media and the political operators have simply not had the bandwidth to focus on the Health Care Compact. They are too busy keeping up with events that are seemingly accelerating out of control. But these crises have one thing in common either directly or indirectly. They are about the economic crisis and governance.

Although the events abroad in the US are not to be directly compared, on an abstract level they all raise the same question: can the current system keep working? The rising deficits suggest that it cannot. Although the Health Care Compact is presently taking a backseat to other, headline grabbing events, it is first cousin to them all. It is about Health Care, which is the central element of the government spending; and it is about the relationship between the Federal Government and the citizens. Like all the other crises it is about a basic question. And no one can tell when it may come to the fore.

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