This commentary originally appeared in The Washington Examiner on March 23, 2017.
Obamacare. The American Health Care Act. The Emergency Medical Transport and Labor Act. The Health Insurance Portability and Accountability Act. Health Insurance Marketplaces (now called exchanges.) The Medicare Access and CHIP Reauthorization Act. Medicare. Patient-centric healthcare. The Unfunded Mandate Reform Act.
These are some of the ways that Washington has "fixed" our healthcare system. Other than failure, they have one other attribute in common: they're Washington-generated, Washington-in-control. For more than 50 years, the federal government has dominated healthcare using a military command-and-control model.
To use a medical analogy, Washington has been the attending physician for a sick patient named healthcare for decades. With all the "treatments" imposed by the doctor-federal government, healthcare has become sicker and sicker, and sicker.
Spending on healthcare has more than tripled, rising from 5 percent of GDP in 1960 to 17.8 percent in 2016. Many accountants fear it will be 20 percent by 2025. That would be a 400 percent increase in 65 years. And what has the public gotten for all that spending?
It is increasingly hard to find a doctor. More than 30 percent of doctors can't afford to accept Medicaid reimbursement schedules. Even as millions of Americans gained health insurance through Medicaid expansion, Obamacare paid fewer and fewer doctors to care for them.
Therapy-by-Washington has made healthcare unaffordable as well as health insurance. Obamacare succeeded in making health insurance even more unaffordable. Now the House Republican healthcare bill, the American Health Care Act, wants to take back the insurance that the government gave for free.
When the same doctor (Washington) treats the same patient (healthcare) over and over with multiple different fixes, and the patient just keeps getting sicker, the problem is not the fixes — it is the doctor. Healthcare needs a new physician, one that is not Washington.
If not Washington, then who? If not by federal regulation, then how?
Instead of looking to Washington to save us with one more fix that fails or backfires, it is time to give the states a chance. Let the states decide on their healthcare. Call it the Fifty Plan. Let the states use whatever model(s) they choose to have and whatever system each wants.
If California wants a single-payer system, let them have it. If Texas wants market-based healthcare, Washington should say let them. If Massachusetts, Rhode Island, Connecticut, Vermont, and New Hampshire want to get together and use one healthcare model for five states, that should be their choice.
Who knows best what Texans or Californians need — Austin and Sacramento, or the federal government? Instead of the one-size-fits-all federal approach, let there be 50 models.
Some negative responses to the Fifty Plan will be the following. (1) "There will be total confusion and chaos. Sick people will fall in the cracks." (2) "What if someone from California gets sick in Texas?" (3) "No state can do it without federal money!"
(1) The system we have now is the epitome of confusion and chaos. It is completely unresponsive to our needs. The Fifty Plan will be as simple, as understandable, and as responsive as we tell our state representatives to make it.
(2) As for our mobile society and getting sick out of your home state, without federal interference, the states can easily make arrangements, deals, and compacts with other states.
(3) Then there is the money. It is Washington's control of healthcare that is driving our nation into bankruptcy while leaving our bridges unmaintained and about to fall down. With the Fifty Plan, states can only spend they money they have. Unlike Washington, the states can't print fiat dollars that add to the national debt.
The phrase "federal money" is a misnomer: Washington has no money of its own. Federal contributions to state Medicaid programs are monies that the states gave Washington in the first place in the form of tax revenue. With the Fifty Plan, healthcare will cost Washington precisely nothing. Each state would therefore expect a proportional return of states' tax revenue that Washington had been previously spending on healthcare.
The Fifty Plan for healthcare is an effective approach to our failing system. It is stark simplicity replacing Byzantine complexity. And seriously, the states can't possibly do worse than Washington has done.