Healthcare Success: Failure and Federalism

Unlocking the key to success in the healthcare debate means understanding failure much more than it entails understanding healthcare.

NCLBWhatever our Congress conjures up is NOT going to be the healthcare panacea they want us to believe it will be. Citizens and legislators must understand this. Ponder their undertaking: do you really think that our federal legislators can create a one size fits all, national healthcare plan that is fully successful on the first attempt? As you mull that around for a moment, allow me to refer you to…. (Drum roll please) ….No Child Left Behind.

NCLB could be defined as a very successful FIRST START. Unfortunately, President Bush, in his last State of the Union Address, asked us to believe the program wildly successful as it stands. (Even Laura doesn’t believe that.) However, if President Bush had asked us to consider that NCLB represents a success because we have learned a lot from it, then that would be an entirely different matter. At the very least, the program has developed excellent metrics, and it has demonstrated initiatives that DIDN’T work and so should not be replicated. There is much in the failures of NCLB on which President Obama can build.

arraFrustration comes from unmet expectations. The American Recovery and Reinvestment Act is a good example. The Administration and Congress are already considering a second stimulus. Does our predisposition towards instant gratification know no bounds? Huge portions of the first stimulus remain unspent, yet we appear ready to conclude that a) the stimulus was ineffective; and b) that even though it was ineffective we should do it AGAIN. Notwithstanding the premature conclusion on the efficacy of the first stimulus, if I grant the premise I’m more inclined to conclude that the initial plan as flawed conceptually and definitely should not be repeated.

If Congress asks the public to believe that the healthcare plan they eventually hoist upon us is the final solution, two expectations are set: first, there will be the expectation by Congress that they must continually tell us how fantastic the new healthcare system is, at the expense of making required changes. Congress will be constantly “selling” their plan to Americans rather than evaluating it for ways to make improvements. Second, Americans will be frustrated because we will see the inefficiencies and problems and will be left with little optimism that tweaks and modifications are forthcoming, particularly in the face of a self-congratulatory Congress.

Congress must acknowledge that with the Bill’s passage comes the realization that healthcare reform will be a PROCESS RATHER THAN AN EVENT. Of course, saying that aloud would be self-defeating. Americans would know that tweaks are coming, creating barriers to investment in the new healthcare system limiting its effectiveness. This is, in part, why healthcare implementation should be left to the states.

taxesCongress should play to its strengths: collecting money. Its strength does not rest in creating and managing national service programs. The states, however, are much better (though not outstanding) at understanding the needs of their residents. State implementation pushes the healthcare debate closer to the people and to governments more responsive to the people than a national system would.

Additionally, it allows for the simultaneous implementation of 50 separate healthcare experiments. Best practices will be derived. Lessons will be learned. States can make subsequent modifications to their own plans based on the success (or failure) of other states’ plans. Fifty smaller programs will be easier to initiate, more nimble to manage, and quicker to change.

Making implementation the responsibility of the States also serves to isolate Congress from accountability and it leaves open the opportunity to create a subsequent National Healthcare System should a States emphasis be a resounding failure. But, if it comes to that, the National System will benefit from the results of 50 prior experiments and the Congress will be able to say that their first instinct was NOT socialist, but federalist in nature.

The Democrats seem determined to push legislation through despite the objections of Blue Dog Democrats and many Republicans. Any plan that is not bipartisan in nature means that the Democrats will have no one with whom to share the blame when version 1.0 flops. Their plan should not only co-opt Republicans but co-opt the States and Americans at large, in order to share responsibility and accountability.

Congress’s role should be two-fold: develop a national means to collect funds that will be extended to the States in order to fund their programs (perhaps a national sales tax); and develop a set of guidelines that each state program must include. Those guidelines ought to provide coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a preexisting condition; coverage that continues even when people are laid off, change jobs, move to another state or start their own business; premiums, deductibles and out-of-pocket expenses that are affordable relative to family income; and the ability to keep current health coverage if desired.

Congress in general and the Democrats specifically, are so busy trying to demonstrate their genius that they will miss the opportunity to truly impress us—with their humility. George Patten said, “Never tell people how to do things; tell them what to do and they will surprise you with their ingenuity.” President Truman similarly noted that “It is amazing what you can accomplish if you do not care who gets the credit.” Our Congress ought to heed these two philosophies and empower and entrust the people and the states to do for themselves.

federalist_papersIt’s true that failure is not an option: it’s an inevitability. A federalist approach, vis-à-vis the socialist boondoggle on the table, creates 50 opportunities for success, and more importantly 50 opportunities to learn from our inevitable missteps. The success of healthcare reform rests not in what Congress produces in the coming months, but rather how well Congress incorporates mechanisms to respond to the shortcomings of their foresight.

Failure, rather than being avoided, should be embraced.

Published in: on July 31, 2009 at 9:15 am  Comments (2)  
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2 CommentsLeave a comment

  1. Great post. Insightful and entertaining as always! Keep up the good work!

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