The United States is more than four years into the Obamacare experiment, and it appears Americans of all ideological persuasions are going to be disappointed by the results.
Those with a free-market, limited government perspective disliked the Affordable Care Act (ACA) for, among other things, giving the federal government powers found nowhere in the Constitution, entangling the government in an immensely personal area of people’s lives, further distorting and regulating what was already a heavily distorted and regulated health care market, creating a new and unaffordable entitlement, and dishing out big subsidies and guaranteed customer bases to big corporations.
Even those of a more progressive persuasion are showing their dissatisfaction, and some have consistently done so since the bill was first signed. Originally, many expressed disappointment Obamacare was not a single-payer plan, one where the government directly pays all medical bills. The favorite alternative idea of a public option failed too, and the track record of Consumer Oriented and Operated Plans has so far been lackluster.
On top of all this, it’s hard to imagine many progressives (or anybody else, for that matter) are pleased to see 40 million or so Americans remain uninsured under Obamacare, a number unlikely to fall below 30 million. Medical costs continue to rise faster than inflation and economic growth, Medicare remains on a path toward insolvency, and Medicaid is still bloating state budgets.
Add to this list patient unhappiness with narrow networks and high deductibles, plus rising health care costs taking a bigger bite out of business and family incomes, and there are ample reasons for people on the left, right, and everywhere else to be unhappy with where Obamacare is taking the U.S. Within a few years, the entire country may want to repeal and replace this failed experiment!
Any discussion of repealing ACA brings up the question of what to replace it with. The two major political parties have seemingly irreconcilable ideas, with one favoring government-run health care and the other preferring greater market freedom as the solution. Washington, DC isn’t exactly a hotbed of cooperation and compromise these days.
There is, however, a solution that could allow for fundamental reforms and achieve sufficient support to pass Congress and be signed by the next president, but it will require both sides to make a single major concession. They must abandon the desire to create a single, one-size-fits-all, national plan, instead allowing states to chart their own course.
For this to happen, Congress will have to pass legislation allowing states to take responsibility for providing health care to the needy in exchange for freedom to experiment based on what their legislatures and citizens think will work best. The payoff for Congress is that block-granting the money to the states gives Congress credit for funding indigent health care while saddling the states with the job of designing and running the program.
The states, however, would benefit from the freedom to design the programs to their own specifications, not those imposed by Congress. Under such a system, different states would pursue different policies, with some looking to enact single-payer programs and others moving toward a truly free market. Some might even decide Obamacare or something like it is the best option.
Congress needs to pass legislation supporting freedom for states without penalty, something the federal government has been reluctant to do in the past. For example, the governor of Vermont requested his state be given control of Medicare within its borders, but the Obama administration rejected the plan. Another state might want to convert its entire Medicaid program into vouchers for health insurance or eliminate the deductibility of employer-provided insurance on federal taxes. These decisions shouldn’t belong to a centralized and inefficient federal government; they should be made by state governments so that local officials can be held accountable.
In modern America, it may seem like a radical idea to allow the states to chart their own destinies, but this is precisely the model the framers of the Constitution had in mind when the country was first formulated. Freedom isn’t a dirty word, and giving states the liberty to make their own choices may be the only option that gives both liberals and conservatives enough of what they want to get controversial and necessary legislation through Congress.
Sean Parnell ([email protected]) is a research fellow for health policy at The Heartland Institute.
