This commentary was originally featured in The Hill on July 10, 2017
While the GOP attempts to repeal-and-replace ObamaCare, Democrats seek to preserve its gains, specifically 17.7 million newly insured Americans and a lowering of the uninsured rate from 18 percent in 2013 to 10.9 percent by the end of 2016. As Republicans struggle to make good on their promise to repeal ObamaCare, the GOP does not want to be perceived as taking insurance away from as many as 23 million Americans.
Both sides of the aisle in Congress have bought into three healthcare lies: big, bigger, and biggest. The big lie says health insurance is what we need. The bigger lie presumes that insurance leads to care. The biggest lie is that government-provided health insurance can provide timely medical care for all Americans.
The big lie
Political leaders, media experts, and Congressional Budget Office analystsdefine success by the number of people with health insurance. After Congress passed ObamaCare in 2010, President Obama clarified the intent of his namesake law: reforming insurance, not care.
Both the American Health Care Actand the more recent Senate version called the Better Care Reconciliation Act, are replete with tax credits, stabilization funds, insurance rule changes, and industry subsidies. The word care is conspicuously absent.
The big lie says healthcare is all about insurance. It isn’t. Healthcare is all about care. A recent articleextolling the virtues of the Senate bill never showed how it would improve access to care.
The bigger lie
The bigger lie says coverage leads to care. Experience in the state of New Mexico shows the opposite: increased coverage leads to decreased care.
Through Medicaid expansion, New Mexico gave new insurance to more than 300,000 individuals. Despite the infusion of $3 billion in additional federal dollars, the cost of the ObamaCare mandates created a $417 million shortfall in the New Mexico Medicaid budget.
To balance the books, the Land of Enchantment’s Medicaid program had to cut its already low payment schedule to doctors even further. As a result, there were fewer doctors to care for Medicaid patients. By increasing the number of government-insured individuals, access to care went down.
The biggest lie
The biggest lie says Washington will provide all the healthcare we need, when and where we need it, for free.
Government-controlled healthcare has two fundamental flaws. First, it is incredibly expensive and extremely dollar inefficient. Forty percent of U.S. healthcare spending — more than $1 trillion per year — produces no care. After the bureaucracy takes the first and largest chunk of healthcare dollars, providers must make do with the leftovers.
Second, the government has only one method to control costs: medical rationing. It cuts reimbursement schedules to providers, limits payments to institutions, and denies authorization for expensive treatments. As a result, wait times to see a family physician are now more than four months, almost half of U.S. physicians cannot afford to accept new Medicaid patients, “307,000 veterans may have died waiting for care,” and we don’t have enough burn units.
The cure to it all
Despite the biggest lie, we keep looking to the Washington for answers. ObamaCare, the AHCA, and the Senate bill are all federally-generated solutions based on federal control. But central control is root cause why healthcare is failing.
With federal control exposed as a cancer in our healthcare system, the cure is obvious: release healthcare from federal control. While the House reform bill and the Senate version both offer states some flexibility and limited waivers of federal mandates, both bills protect Washington’s rigid, complex, dollar inefficient, and extremely costly regulatory and administrative structure.
With both bills, the cancer remains intact and growing. For five decades, Washington’s fixes for healthcare have made things worse, not better. It is time to release healthcare from federal domination. Healthcare should return to the states, where it belongs.
Advocating for a single payer healthcare system in his home state, California State Sen. Ricardo Lara (D-33) said, “Given this picture of increasing [federal] costs, health care inefficiencies and the uncertainty created by Congress, it is critical that California chart our own path.” Despite Gov. Jerry Brown’s fear that single payer “can’t work,” shouldn’t the Golden State be allowed to decide for itself. Other states should be afforded similar freedom instead of having Washington impose its one-size-fits-all model on everyone.
Not only are the states more responsive and more dollar efficient than Washington, they can also serve as testing grounds recommended by U.S. Supreme Court Justice Louis Brandeis. In the 1932 case New State Ice v. Liebmann, he wrote that a “state may, if its citizens choose, serve as a laboratory” to “try novel social and economic experiments without risk to the rest of the country.” Healthcare needs Justice Brandeis’ “laboratories of democracy.” The states are the perfect vehicle.