Let the states reform health care

Opinion: February 23, 2010 at 12:00a.m.

By ROBERT MOFFIT

The vast majority of Americans want health-care reform. They just don’t want the monstrous telephone-book-size bills now before the House and Senate.

They don’t want to be ordered about like medieval serfs, being told what they can and cannot do; what they must and must not have. They don’t want to be insulted by arrogant politicians who claim to know what’s best for the public and their families. And one more thing: Americans don’t want to be told — repeatedly — things that are transparently untrue — that, for example, they’ll be able to keep the health plans they like and have now, or that Congress is a powerhouse of fiscal conservatism and is going to bend the health care spending curve downward. In an open society, where a free and increasingly angry people can still read, write and vote, there is still the slim possibility that these distant representatives will finally “get” it.

A creative force

So let’s bank on that slim possibility. Instead of trying to ram through a massive spending and entitlement bill, chock-full of mandates, taxes and fines — or trying to chop it up and smuggle the bits and pieces outside of the congressional budget process — why not enlist the creativity of the states? The states are 50 laboratories for reform. Congress could provide grants funding, technical assistance and waivers from federal law and regulation to let them experiment with bold ideas. Lawmakers could tie funding or assistance to some commonly agreed-upon national goals, such as lowering the uninsured rate, reducing health care costs and improving the health sector’s quality of services.

Liberals and conservatives in Congress and elsewhere can agree on these basics. Then they can see what works. In some instances, states have already taken the lead. States as ideologically different as Massachusetts, with a health-insurance coverage rate of 97 percent, and Utah are embarking on consequential and far-reaching reforms. It’s hard to imagine two more different places within the same country.

No single answer

One might love or hate the Massachusetts or the Utah approach to health reform, but one can always pursue something entirely different. States could plow ahead with serious reforms that already resonate with the American people: capping medical malpractice lawsuit awards; reforming the health insurance markets; and improving the safety net so that the sickest and poorest Americans are better able to obtain affordable coverage. Let’s look at the medical malpractice issue. President Barack Obama has given lip service to it with promises of pilot demonstrations. But these pilot programs would lack teeth and would fail to curb the litigious incentives for trial lawyers to bring cases that seek a lottery payout.

States could enact protections for patients’ rights while assuring physicians that they won’t be forced out of medicine because of skyrocketing liability premiums. Additionally, states should take the lead in reforming the broken health insurance markets. They should guarantee portability of coverage from job to job and access to affordable coverage for those with pre-existing medical conditions. States also can enter into interstate compacts with each other, expanding the geographical and population size of their insurance pools, and inviting more robust competition.

Congressional role

While Congress can set some conditions on state experimentation with federal funds, they should recognize that state markets differ radically. That’s why home-grown reforms tailored to the prevailing conditions in the states make the most sense. This approach also gives Congress and the voters the best chance to see how various health-care models stack up against each other. It’s a lot better than, say, imposing a Massachusetts model on the entire country, as some politicians want to do. Everyone knows there are problems with the health care status quo.

That’s why Washington politicians insult us when they insist it is their way or the status quo. That’s a false choice. Let’s allow states to compete in the arena of health policy ideas and see which ones best achieve the nation’s universal health-care goals.

X Robert Moffit is the director of the Center for Health Policy Studies at The Heritage Foundation, Washington, D.C. Distributed by McClatchy-Tribune Information Services.