The moral path for re­peal­ing Oba­macare

There is no le­git­i­mate con­sti­tu­tional ba­sis for a cen­trally-planned health­care sys­tem

The Washington Times Daily - - OPINION - By Blaine Win­ship[ Blaine Win­ship was the lead trial coun­sel for 26 states in their law­suit chal­leng­ing Oba­macare. He is the au­thor of “Mo­ral­nomics: The Moral Path to Pros­per­ity” (Mo­ral­nomics Press).

Many ideas are be­ing floated for chang­ing Oba­macare. For the most part, they fall into three camps: those urg­ing some tin­ker­ing at the mar­gins of the ex­ist­ing struc­ture, those ad­vo­cat­ing to­tal re­peal, and those fa­vor­ing re­peal and re­place­ment. By far, the best choice is none of the above. In­stead, the mantra should be “re­peal and re­di­rect,” shaped along the fol­low­ing lines: Start by agree­ing on the end-vision, then work back­wards to for­mu­late the steps needed to tran­si­tion from here to there over the next two years. As the tran­si­tional steps are rolled out, the end-vision should be kept in mind, lest ill-con­sid­ered in­terim mea­sures un­der­mine re­al­iz­ing the ul­ti­mate goal.

The end-vision should in­clude a sig­nif­i­cantly re­duced role for the fed­eral gov­ern­ment. Our Con­sti­tu­tion was de­signed to keep po­lit­i­cal power closer to home, with a fed­eral gov­ern­ment of limited pow­ers, and with the states re­tain­ing sovereignty over the tra­di­tional “po­lice power” for the health, safety, and wel­fare of the peo­ple. There is no le­git­i­mate con­sti­tu­tional ba­sis for a cen­trally-planned na­tional health­care sys­tem.

Con­sis­tent with the Con­sti­tu­tion’s de­sign, Med­i­caid should be dras­ti­cally al­tered, and then grad­u­ally phased out. To start, Med­i­caid funds should be block­granted to the states with no strings at­tached, save that the funds be used to en­able the poor and needy to pur­chase health in­surance and med­i­cal ser­vices and sup­plies as they choose. The fed­eral gov­ern­ment’s role in set­ting thou­sands of health-re­lated prices should be ended.

The fed­eral gov­ern­ment’s prac­tice of over­tax­ing the states’ peoples and busi­nesses, then re­turn­ing rev­enues to them via grants, should be phased out through re­duced tax­a­tion, leav­ing gov­ern­ment’s role to be de­cided and funded at the state level. (Once the Med­i­caid over­haul suc­ceeds, let’s re­visit Medi­care.)

States then should al­low pri­vate health in­sur­ers to of­fer cov­er­age on a more ra­tio­nal and var­ied ba­sis that bet­ter re­flects what cus­tomers want. If cus­tomers re­turned to buy­ing ba­sic ma­jor med­i­cal cov­er­age and pay­ing out-of-pocket for rou­tine pro­ce­dures and most phar­ma­ceu­ti­cals, pre­mi­ums would plum­met. Health sav­ings ac­counts (tax-shielded ac­counts that re­ward in­di­vid­u­als for shop­ping around for lower prices by let­ting them re­tain whatthey save) would bet­ter en­able them to af­ford these ev­ery­day costs, and lead to sig­nif­i­cant re­duc­tions in hos­pi­tals’ and doc­tors’ charges. For the poor, vouch­ers (pro­vided by States from block grants) to fund health sav­ings ac­counts would en­able them to reap the same ben­e­fits of shop­ping around for lower prices. Congress should act to pro­tect health sav­ings ac­counts.

Health in­sur­ers should be al­lowed to op­er­ate across state lines, the bet­ter to pro­mote com­pe­ti­tion and max­i­mize con­sumer choices. This elim­i­na­tion of in­ter­state trade bar­ri­ers would lead to higher qual­ity and lower prices. (As for fos­ter­ing com­pe­ti­tion among providers — hos­pi­tals, clin­ics, physi­cians, etc. — an over­haul of an­titrust laws and en­force­ment is needed to pre­vent or undo ex­ces­sive mar­ket con­cen­tra­tion.)

The states should be al­lowed to func­tion as the lab­o­ra­to­ries of ex­per­i­men­ta­tion that our founders en­vi­sioned. No one has a mo­nop­oly on good ideas, and of­ten we sim­ply can­not know how the best-laid plans will work in the real world. State of­fi­cials should be at lib­erty to try out dif­fer­ent ap­proaches, and to adopt other states’ suc­cess­ful pro­grams while avoid­ing their fail­ures. Mis­takes surely will be made along the way, but the states are far bet­ter po­si­tioned to cor­rect er­rors than is the fed­eral gov­ern­ment — as the long-fought cam­paign to re­peal the Oba­macare disas­ter il­lus­trates.

If all or most of these steps are im­ple­mented by Congress, and if the states re­act by work­ing with providers and in­sur­ers while keep­ing the con­sumers’ best in­ter­ests at heart, we will be amazed at how quickly mar­ket forces kick in to bring about huge im­prove­ments in the med­i­cal sec­tor of our econ­omy, with sellers suc­ceed­ing by pleas­ing cus­tomers bet­ter. This is what hap­pens when we em­brace the moral­ity of the mar­ket.

The states should be al­lowed to func­tion as the lab­o­ra­to­ries of ex­per­i­men­ta­tion that our founders en­vi­sioned.

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