Should Washington Be Looking To The States For Health Care?

"T-Paw doesn’t have many fans among the hard core, Christian conservative base, but he’s a charismatic, moderate figure who may break out of the pack some time in late 2010 or early 2011."

T-Paw also doesn't have a lot of fans in Minnesota either. His governing strategy isn't tax and spend, but borrow and spend with a health dose of cutting social services for people who need them.

What is somewhat ironic is that the MN plan that Gov. Pawlenty lauds is essentially what everyone in his party has been opposing on a national level - a government run insurance option. This was covered in this article http://www.minnpost.com/politicalagenda/2009/08...

Amusing, if the truth wasn't more tragic. Missouri's idea of innovation was to cut thousands of people from Medicaid when hurting mildly well before the recession. When more income was discovered to be available their next innovation was to refuse to restore any funds to Medicaid. Their next flash of brilliance was to refuse to use stimulus funds to help Medicaid but propose that any money should be used for...tax rebates. Yes, the Missouri legislature (and governor while much of this was going on) is Republican.

Jim -- what does Missouri have to do with Minnesota or Massachusetts?

It's a counter-example to the idea that states have such wonderful ideas on health care. It's not the only one, obviously.

Looking to the states as we should be doing to respect constitutional federalism and be grown-up Americans? Quaint, passe', long obsolescent, and reviled by lefties for decades. Nope, try again.

Looking to the states as models or test cases for federal health care expansion? I doubt the lessons will be learned. That the current federal effort (in whatever form it has been put today, or this current hour) is different, though the goal is the same (government health care), is all the excuse that's needed to ignore the lessons of Massachusetts, for example, though the larger problem is the refusal from the start to look to the states.

That provision of health care by government, any government, is simply one choice we have rather than something sacred or "obligatory" is beyond the reach of too many government-health-care proponents.

"T-Paw seems to be picking an ideal time to dip a toe into this particular pool"

Don't forget the "national level" (federal office) pool, including the Presidency. If Palin can do it, why not others? The GOP's current state is weak, like a cloudy little pool full of minnows. It's an opening to be exploited not limited necessarily to the federal health care fiasco-currently-in-the-works.

"...reminds people that the Democrats have gone back to their old tax and spend ways without remorse."

I know, it's horrible isn't it. Things were so much better in the old borrow and spend days under Bush. That way problems didn't exist!

God, all this whining and moaning about taxes for healthcare makes me wish Bush HAD suggested that taxes raises would be required to fight the War in Iraq. That would have cooled the patriotic fervor, no doubt.

Lit3--

It's worse than you think. Not only did the Republicans borrow and spend during the Bush years on the wars, the Republicans also borrowed and spent on health care during the Bush years!!!

"That provision of health care by government, any government, is simply one choice we have ."

Unless you have a pre-existing medical condition and then you it is pretty much your only option. My younger sister has Cystic Fibrosis, a genetic condition. She's on a number of maintainence medications that help keep her health and out of the hospital. Our father is self-employed and our mother's work doesn't offer health care. There is no way she can get private insurance. Instead she is on a government created health plan for people like her that enables her to actually get health insurance. Yet she still has to pay higher premiums than the market place.

"'That provision of health care by government, any government, is simply one choice we have.'

Unless you have a pre-existing medical condition and then you it is pretty much your only option. [...]
she is on a government created health plan for people like her that enables her to actually get health insurance. Yet she still has to pay higher premiums "

Yes, the assigned-risk pool (or whatever other term is used in your state for this as well as auto insurance).

1. I'm fully aware of the pre-existing condition problem since the 1980s, in my own case. In one state I was either refused insurance completely or charged a lot (I ended up paying about $750 a month for a single-person policy) and in other states I've been in I've frequently had riders and exclusions enabling non-payment for pretty much anything that could be argued to be associated with my condition. For a few years now I've been paying in the low-mid $300s a month for myself. I haven't had to resort to the high-risk program, but I'm aware that it's expensive (can be four figures for an individual, limited policy).

2. Advances in genetics and identification of predispositions to diseases, once this is broad and routine, is what typically has been anticipated to spell the death knell for health insurance (both real insurance, against catastrophe, including serious diseases as well as injuries such as in auto accidents, and what we have now, periodically-pre-paid comprehensive health care).

3. Private insurance can be made available to all and denied to none though an alternative I have mentioned before, state-wide, region-wide, or nation-wide "community rating" legislation combined with prohibitions on existing-conditions restrictions and with likely compulsory participation by all (including the young and healthy, to lower the per capita costs). (Note that even government health-care proponents can support this with gusto, because to pay for this would typically involve mandatory participation and payment, which is a pre-arrangement in some form of taxation to pay for eventual government health care.)

4. A suggestion for a "public option" right now could be directed only or primarily at the high risk people (such as AIDS and cancer patients, though there are other diseases at issue, too) with more generous subsidies if need be, which would be more palatable to the public than an "option" meant as a takeover of health care for everyone eventually by the federal government (accompanied by prospects that raise more concerns). Naturally there will tend to be a movement toward including more and more under subsidized insurance (pre-paid health care, as state and no doubt federal laws will require generous benefits sets).

5. Speaking of states, why not let people buy insurance across state lines? While this would disappoint the most insistent right now, and raise other issues (state insurance commissioners would have no power over out-of-state insurers; there might need to be a new federal commissioner for that), it would actually involve real competition among insurers (when they didn't rig the market, refuse to cover people out of state on their own accord or deliberately charge them exploitive or prohibitive rates, etc.), it would be another gradual move toward nation-wide and ultimately federallly-controlled (and provided) health care that, again, would be less alarming to the public than what we're seeing with the current crazy rushing.

"She's on a number of maintainence medications that help keep her health and out of the hospital."

And yes, it's bitterly ironic to face the situation wherein for years you may be savvy on finance (maybe being taught by your grandmother, and being a reader who stumbles on the subject out of your own interest, as in my case), but your spare "investment" dollars get "invested" on meds to keep you alive.

"2. Advances in genetics and identification of predispositions to diseases, once this is broad and routine, is what typically has been anticipated to spell the death knell for health insurance (both real insurance, against catastrophe, including serious diseases as well as injuries such as in auto accidents, and what we have now, periodically-pre-paid comprehensive health care)."

Which isn't overly helpful to people who can't get insurance now.

"3. Private insurance can be made available to all and denied to none though an alternative I have mentioned before, state-wide, region-wide, or nation-wide "community rating" legislation combined with prohibitions on existing-conditions restrictions and with likely compulsory participation by all (including the young and healthy, to lower the per capita costs). (Note that even government health-care proponents can support this with gusto, because to pay for this would typically involve mandatory participation and payment, which is a pre-arrangement in some form of taxation to pay for eventual government health care.)"

That doesn't mean that it would be affordable for the person. Nor does it mean it would cover things that needed to be covered since people with chronic conditions tend to need higher levels of care - more frequent check-ups, more specialists to consult with and a smaller pool of possible providers.

"4. A suggestion for a "public option" right now could be directed only or primarily at the high risk people (such as AIDS and cancer patients, though there are other diseases at issue, too) with more generous subsidies if need be, which would be more palatable to the public than an "option" meant as a takeover of health care for everyone eventually by the federal government (accompanied by prospects that raise more concerns). Naturally there will tend to be a movement toward including more and more under subsidized insurance (pre-paid health care, as state and no doubt federal laws will require generous benefits sets)."

And how is this a bad thing? More people covered, more generous benefit sets, and high risk people can actually get the car they need. If the private industry can't compete then they need to get out of the market.

"5. Speaking of states, why not let people buy insurance across state lines? "

Because of what happened when we let people do banking across state lines.

"'Advances in genetics and identification of predispositions to diseases [...] the death knell for health insurance"

Which isn't overly helpful to people who can't get insurance now."

Not everything I chose to say was intended to provide or promote a solution to the current problem. This was to say rather that the problem is actually broader and eventually will be greater than it is now. (It's also a logical argument for eventual replacement of private insurers with public health care.)

"'Private insurance can be made available to all and denied to none though an alternative I have mentioned before, state-wide, region-wide, or nation-wide "community rating" legislation combined with prohibitions on existing-conditions restrictions and with likely compulsory participation by all'

That doesn't mean that it would be affordable for the person. Nor does it mean it would cover things that needed to be covered since people with chronic conditions tend to need higher levels of care - more frequent check-ups, more specialists to consult with and a smaller pool of possible providers."

I would respond that right now, most "insurance" already is comprehensive health care, complete with the usual example of extending beyond "sick care," namely preventive care. This is one reason why so much "insurance" is so expensive -- because so much is expected and even mandated by law. (This is the great lesson the advocates of public health care have yet to learn, while at the same time the current Congressional members doing the following are hypocritical -- while supporting comprehensive health care, at the same time they want to tax and punish the most comprehensive private health care on the grounds that it encourages people to use health care services too much. Related to this irony or this hypocrisy is that a) so often the people who need preventive care and are provided don't use it -- and that it would wrongful for the feds or for activists to demand its use be made compulsory behavior by law; b) what we see with government and activists all the time is the demand for more, not less, things to be provided.

Aside from establishing the scope of what should be provided, if the result were unaffordable, it would then be the subject of income or expenditure assistance (subsidies), presumbably.

"'A suggestion for a "public option" right now could be directed only or primarily at the high risk people [...] Naturally there will tend to be a movement toward including more and more under subsidized insurance (pre-paid health care, as state and no doubt federal laws will require generous benefits sets).'

And how is this a bad thing? More people covered, more generous benefit sets, and high risk people can actually get the car they need. If the private industry can't compete then they need to get out of the market."

More people covered, more generous benefit sets means much greater cost and cost growth. There are limits in cost-effectiveness and practicality that will have to be faced (now, with eventual limits to how much we can pay, for what, when aging-as-well-as-advances-related cost increases in the future 10-20+ years force additional limitations on our ability to pay). Even routine _testing_ of people for symptoms of some chronic diseases, for example, has been examined and rejected on cost-benefit analysis (example: proteinuria to screen the population for evidence of kidney disease).

"'Speaking of states, why not let people buy insurance across state lines?'

Because of what happened when we let people do banking across state lines."

I never had a problem with Bank of America no matter what state I was in (other than their annoying insistence on still knowing what state I opened my accounts in, as they still have different paperwork for different states of origin, which makes no sense after 10+ years). When I was in Arizona, I cut costs as long as I could with health insurance by continuing to purchase Washington state insurance until those folks ceased accepting and retaining out-of-state clients.