The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Another Health Care Reform Disconnect (collect them all)

Posted by Alan on January 7, 2008


Dealing with health care reform does strange things to people, especially to politicians. Regardless of party. For example, it’s not uncommon to hear Democrats bemoan President George W. Bush’s veto of the State Children’s Health Insurance Plan (SCHIP) expansion and criticize California lawmakers for cutting back on health services to balance the current (now severely out-of-balance) state budget, while at the same time proclaiming that the way to improve health care is to turn it all over to the government to handle. That this is the same government that vetoes SCHIP and cuts health services doesn’t seem to faze them. Maybe I’m missing something, but isn’t this a serious disconnect between reality and theory? 

The GOP can disconnect principles from proposals, too. There are Republicans who frequently call for letting the states chart their own course on issue after issue, but who also propose doing away with a state’s ability to regulate the health insurance carriers and HMOs selling to its citizens.

I was chastised by a reader for an earlier post that discussed GOP lawmakers taking themselves out of California’s health care reform debate by refusing to consider any tax increases under any circumstances. “Since you are not a Republican, do not waste your time trying to think like one,” wrote Tom Johnston. A fair point and a kindly phrased suggestion, concerning those he could have made.

So I know I’m on thin ice here, but …. If it’s inappropriate for the federal government to tread on a state’s rights, isn’t it just as wrong for it to empower other states to intrude on those rights? If New Hampshire has one regulatory scheme, should health plans be able to sidestep it by filing in Wyoming? Won’t this jurisdiction shopping process simply lead to carriers filing in the state with the most industry friendly regulation? If regulations in a state are too severe, shouldn’t the voters of that state demand changes, not have it thrust upon them by voters somewhere else?

Yet, according to a Kaiser Family Foundation web site tracking the health plans of presidential candidates, this is exactly what health care reform proposals put forward by former-Mayor Rudy Giuliani, Congressman Duncan Hunter and Senator John McCain would do. Of course, they don’t put it this way. Instead it’s couched as “Permit individuals to purchase insurance across state lines.” Or “Promote competition and individual choice of insurance by allowing insurance to be sold across state lines.” Sounds better, but it’s the same result.

Eliminating unnecessary regulation is one way to reduce the overall cost of health insurance. But promoting states’ rights on one hand while eliminating their ability to regulate health insurance plans sold within their borders makes as much sense as condemning how poorly the government deals with health care on one hand while giving it complete control over the entire health care system on the other.

As I said, dealing with health care reform does strange things to people.

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