At the crux of the current and contentious, nearly decade-long, debate over health care is one question: What the hell is our objective? For me, the humane objective is to ensure that everyone receives the medical care they need when they need it. In doing so, we must incentivize personal responsibility and supercharge our sense of moral obligation to provide medical care for those who are unable, at any moment, to obtain it on their own. But, as our all-knowing yet ever-learning president discovered, achieving this objective is complicated.
One solution currently on the table is the <a href=”http://www.politico.com/interactives/2017/graham-cassidy-health-care-bill-what-you-need-to-know/” target=”_blank”>Graham-Cassidy</a> health care bill in the United States Senate. Its premise is easy to understand: States, not the federal government, is where we will find solutions. This is the wisdom of the state block grant idea. This idea would allow each state to meet the unique needs of the uninsured in that state. So, if you were wondering, yes, the Senate ought to pass the Graham-Cassidy health care bill.
I know, I know. If you have not heard, you will hear that there are a million reasons to not support the bill. But, frankly, most of those reasons use a baseline drawn from the particulars of Obamacare. The point of these objections can be summed up by the circular argument that what now exists will not exist. Yes, we get it. If you repeal Obamacare, it will go away. But that is not the end of the story.
If not Obamacare, then what? Essentially, we would have fifty laboratories of democracy each trying to meet the real needs of their people. This would become the new baseline. Innovation would take place in the states. Among the states is where we will find that success is easily replicated. They just need to be free to do so. That is where Graham-Cassidy comes in – a nice balance of funding and freedom.
Once solutions fall back into the hands of the states, we will see that there is more than one way to skin a cat. Based on its own commensurate values and living up to its typically idealistic expectations, California might choose to supplement its block grant with large doses of state funds. Whereas, Utah might be able to do more with less, as it does in education. (Although <a href=”http://www.cnn.com/2017/09/20/politics/health-care-graham-cassidy/index.html” target=”_blank”>Utah’s funding</a> would go up, not down, in the Graham-Cassidy bill.)
If left to innovate, states would provide the uninsured with enough options to get medical treatment when needed. For some, such as the permanently disabled, the answer would remain traditional Medicaid. For others, such as healthy young single adults, an answer could be affordable basic catastrophic coverage. Still, for others, such as the able-bodied, work requirements could be part of the answer. Once we create a new state baseline of public expectations centered on our commensurate values, anything is possible and everyone can get their needs met.
The free market provides the best functional mechanism to incentivize personal responsibility. Let the marketplace do what the marketplace does best. For instance, let health insurance companies provide plans within a for-profit business model in a truly competitive environment. Of course, a true free market only works if we also prevent anti-market behaviors from both government agencies and commercial providers.
As with medical ethics itself, material self-interest among health care providers cannot be their primary interest. Yes, competency is expensive but competence is not necessarily tied to the size of the fee charged. Yes, we want new medicines to relieve human suffering but what is a cure if it is so expensive it is unavailable to most people? Profiting from human suffering is not the same thing as being reasonably compensated for relieving human suffering. Health care is the perfect marketplace to embrace social and moral frameworks that meet our commensurate values. When those two things align, medical care would be available to all without sending anyone to the poor house.
But it all begins with a systemic policy change. We need a new baseline from which to measure any successful healthcare policy. The baseline for Obamacare is confusing and often contradictory: Federal government-managed, insurance company-provided health care. Its focus is on government managers and insurance company profits and losses. The Graham-Cassidy bill creates a new baseline: A fifty-state, solution-oriented approach. Its focus is on effectively providing medical care for all people who need it, regardless of how that need is met.