Marching Through Georgia

Only days after Arizona Governor Jan Brewer vetoed a similar bill,  Georgia became the first state to sign the Health Care Compact Bill into law.  Governor Nathan Deal signed House Bill 461 "which allows states to work together on health care in an effort to avoid mandates from federal legislation adopted last year. But, since any compact requires congressional approval, many see Georgia's move as largely symbolic."

Businessweek earlier said "the bill would allow Georgia to create alliances with other states on health care. Compact bills have been popping up in several states, pushed by tea party groups as part of a national states' rights push. Democrats argued the bill was about politics not health care. They said supporters were simply trying to snub President Barack Obama and his federal health reform law."

The tin-foil hats are now on in full force.  One blog site called the Health Care Compacts "the newest scheme to destroy Obamacare ... Egged on by tea partiers, at least a dozen states are now contemplating legislation that supporters believe would allow them to seize control of and administer virtually all federal health care programs operating in their states and exempt them from the requirements of the health care law ... bankrolled by the right-wing heir to a Texas construction company fortune."

Nothing could be further from the truth, said its proponents. Writing in the National Review, Leo Linbeck III, the vice chairman of the Health Care Compact Alliance, argued that the Compact movement was not about Obamacare at all.  That was only incidental, at it's core the movement was about "who decides". The health care issue was simply where this principle cried out most for application.

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.

In the Health Care Compact's submissions to Tennessee, another state which is considering the compact, the proponents point out that President Obama himself performed a signal service by putting healthcare in the center of the deficit debate.  In that the President was indisputably correct.  What was now up for debate was what to do about it. The Health Care Compact advocates argued that the next logical step should be for the States -- the individual laboratories of democracy -- to solve it as best fites their circumstances. In fact they could choose Obamacare if they wanted. Nothing in the Health Care Compact idea prevented states from embracing Obamacare or going beyond it to a single payer system if they wanted to. In the Washington Examiner, Linbeck wrote:

Each state should craft its health care policy to fit the needs of its residents. 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.

That assurance was unlikely to mollify the critics of the Health Care Compact movement. Not only was it provocative on a process level --  calling for a comparatively smaller role for the Federal Government -- but it touched on the very sensitive matter of money, especially on that most delicate of questions, namely: who gets it. The Health Care system encompasses one sixth of the American economy. The Obamacare system provided a unique opportunity to redefine who the winners and losers would be. But under a system where the States could craft their own solutions in cooperation with others, there would a competition in the kind of playing fields provided. Those who stood to gain under Obamacare would certainly seek to brand their rivals as "right wing" kooks.

For good or for ill, the Health Care Compact has entered into a money minefield in which the stakes are mind-bogglingly high. The problems are highlighted by the situation of AARP, a powerful lobby group for retired persons. According to its mission statement, it is "a nonprofit, nonpartisan membership organization for people age 50 and over ... dedicated to enhancing quality of life for all as we age," which "provides a wide range of unique benefits, special products, and services for our members."

The trouble is, "AARP does a 'thriving business' in marketing branded Medigap policies" which has led critics to accuse it of favoring legislation, such as Obamacare, in order to further its business interests. The Huffington Post quotes "Democratic insiders" have "been left wondering why the American Association of Retired Persons, the powerful lobby for older Americans and the defender of all things Medicare, has been largely sitting on the sidelines."

After all, the budget proposed by House Budget Committee Chairman Paul Ryan (R-Wis.), if signed into law, would slash Medicare and convert it to a system of government subsidies for private insurance. AARP has put out a statement raising concerns about that plan and fired up an email campaign to oppose it, but several Democratic operatives said they had hoped the lobby would do much more.

If you can't trust AARP, then who can you trust? Perhaps no single entity where such staggering sums of lucre are involved. One possible reason for AARP's fence-sitting is that they are now hedging their bets. Obamacare, in its present form, is probably dead because there simply isn't enough money to afford it. Nor enough political support. Rasmussen polls say that support for Obamacare fell to a new low in April 18, 2011. But voters are aware that something needs to take its place. The polling organization wrote:

a majority of voters continues to favor repeal of the national health care law, but the number who Strongly Favor it has fallen to a new low. So has the number of voters who see the law as bad for the country.

The latest Rasmussen Reports national telephone survey of Likely Voters shows that 52% favor repeal of the health care law, while 41% are opposed. But now just 39% Strongly Favor the law’s repeal, the lowest level measured since the plan’s passage last year.

The King is dead. Long live the King. But who is the King? Maybe there will not be one monarch but several princes. That narrative fits in neatly with that of Health Care Compact advocates. With Obamacare dying at the polls and already in the fiscal mortuary, the emergence of a single global health care reform deal may not be the cards. Yet some change must come to the health care system anyway. It is too broken to be left alone. So states may seek to find a solution based on their own capacity to pay and political inclinations. If the deadlock in Washington goes on long enough, then something like the Health Care Compacts will naturally transpire because there is nowhere else for anyone to go.

With the passage of House Bill 461 through Georgia, two things have happened. The Health Care Compact is now seriously on the table, whatever "Democratic insiders" might say, up in one state and counting. The second is that, quite without fanfare, a wider issue -- the question of "governance" -- has now become part of the national political agenda. As the Federal Government ties itself in knots, a massive tangle of lobbyists limbs and special interests, some enterprising politicians need to move forward or face bankruptcy. It may not be the bus some Democrats have been waiting for, but at least it's leaving now.


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