Repeal and replace. Those were the two words that captured the imagination of Americans who opposed the lumbering leviathan known as ObamaCare. We turned out by the millions at the polls to help make those two words a reality.
But those two words beg the question: Repeal and replace with what? With that great old way of doing health care in this country that we had before Obamacare?
To the good old days when the federal government S-CHIPed it’s way – a few million families at a time – to a single payer system? To that great old system where federal bureaucrats wear down doctors with ever decreasing reimbursements, and states with more and more burdens? To that old way of doing business where federal officials make more and more decisions about the quality of our care, while the patients and doctors back home make fewer and fewer?
There is a new word floating about in conservative circles that is shorter – and better – than Repeal and Replace; it is called nullification. And the road to nullification is through an initiative you’ll be hearing soon called the health care compact.
It goes something like this.
Suppose there were to be a state, or a few states, that decided the old way of doing business in health care just wasn’t working for them. That the cash the federal health care bureaucrats in DC was sending to the states was not enough to cover the accompanying obligations, and that there had to be a better way to run a rodeo than this. Imagine if that state – or a few states – simply said “Enough already!”
That is the vision behind the health care compact concept; end the dependence on ever diminishing federal support for programs like Medicare and Medicaid, opt out of the federal system altogether and form a compact among and between some states, and see if the locals can’t do a better job than the fat crats in DC.
The upside of the compact, if it works, is this; it would reduce the scope of Washington’s power. States, not Congress, the White House, or federal bureaucracies, would set the rules for health care, from Medicare and Medicaid to personal insurance policies.
In the words of left wing folk singer singer Tracy Chapman, we’re “talkin’ about a revolution” if this idea catches on. And if we can get the compact to work in health care, we could soon return other areas of federal control to the states. To the people.
Isn’t that what the 2010 elections were all about in the 1st place. And our Constitution?
So how would this all work? Is there any precedent for this, or is the compact just another pipe dream, like tax reform or deficit reduction?
As Bill Kristol pointed out in a very good column about this subject back in early January, “Interstate compacts aren’t a wild idea. They just haven’t been tapped for such a political purpose before. The authority for compacts was established in the Constitution (Article 1, Section 10), and more than 200 have been set up. One example: the agreement uniting Maryland, Virginia, and the District of Columbia to build and operate the Washington area’s Metro subway system.
Kristol notes that there is an even bigger – and better – reason to form compacts. By banding together, states would have substantially more political clout in Washington, DC. Which is exactly how the founders intended things to be back when they designed our federal system.
What good would local control do? Well, for openers, driving such important matters to the states would allow for more choice, and for more innovation. Some states will do better than others, and allow more adaptation – and adoption. Adopt the good, and toss away the bad.
More important, it would allow for more citizen control. And less control in the hands of people with little vested interest in outcomes, living thousands of miles away from those who are paying the bills.
As the weeks and moths pass in 2011, keep a lookout for the word 'compact.' It may just be the best way to beat ObamaCare. Not just by repealing and replacing one bad law with another, but by returning power to that pesky little interest group known as We the People.