State Sovereignty Resolutions: The NY Times Weighs In

A number of state legislatures are considering resolutions affirming their constitutionally-based resistance to the federal government taking over every American’s access to medical services.

According to the New York Times, legislators sponsoring these resolutions are merely carrying water for various corporate interests in the health sector.   Conspiratorially, the NY Times asserts that the idea of state sovereignty over health care popped up at the Goldwater Institute in Arizona, and was then picked up as a theme at the American Legislative Exchange Council (ALEC).  The NY Times asserts that this was because ALEC’s Health & Human Services Task Force is “overseen” by a four-member panel composed of representatives from the Blue Cross/Blue Shield Association, Johnson & Johnson, Bayer, and Hoffmann-La Roche.

Good Grief!  I am a private-sector member of the ALEC HHS Task Force, and I can assure the world that nobody “oversees” it.  It is a lively forum of discussion about model legislation that adheres to principles of limited government.  The push for state-sovereignty resolutions is led by legislators such as Linda Upmeyer (Iowa) and Rep. Nancy Barto (Arizona), supported by various think-tank members, such as Clint Bolick of the Goldwater Institute and myself.  (I testified at a committee hearing in Arizona on that state’s proposed resolution.)  Dr. Eric Novack, an orthopedic surgeon, launched the campaign for state sovereignty over health care.

I would be amazed if the Blue Cross/Blue Shield Association, Johnson & Johnson, Bayer, or Hoffmann-La Roche, cared a hoot about state sovereignty over health care.  But according to the NY Times, appeals to limit federal power over access to medical services can only come from corporate lobbying.

Child, Convict, or Mental Patient?

“We primarily incarcerate, educate and medicate.” — Gov. Chet Culver (D-Iowa).

Some education reformers might say that too often, public schools combine all three functions. It’s an interesting juxtaposition of functions.

The education function is focused on children–people too young to make decisions on their own.

The medication function can refer to people in many different situations, but I suspect that the people in state health programs today are more likely to be mentally incompetent than the population at large.

And of course the incarceration function applies to people who have broken the laws of the state.

Thanks to the personal mandate in the forthcoming health bill, you’ll be treated both as a child and a mental incompetent–and if you refuse to comply, you’ll be a criminal.

Iowa Gubernatorial Candidate Touts Health Care Cures

Who says that health care is strictly a national issue? Chris Rants, who is seeking the Republican nomination for the office of governor in the state of Iowa, is on the stump with four ideas for addressing health care costs: electronic records for all within four years; paying hospitals for quality and not simply number of services; creating a state website that lists prices at various hospitals; and medical malpractice reform.

An Incomplete Proposal from Iowa

Another politician, this time in Iowa, is making noises about keeping health care policy in the states. The story about five Republican gubernatorial candidates in Iowa is just a tease, and gives no clue as to the prospects of the candidates, or even much of what they think. But it's interesting and heartening to watch the blowback:

Bob Vander Plaats, a business consultant from Sioux City, was the only gubernatorial candidate to mention the national health care reform debate.

"This health care debate's a debacle. They're trying to sell you something good and they're hoping that you'll buy it because they can have total control. It'll be a complete loss of your freedom," Vander Plaats said. "It's time we have a governor who will stand up for the 10th amendment and Iowa's sovereignty from the federal government and say, 'We will run our own health care in the state of Iowa. We will not let the government run our health care for us.'"

Vander Plaats did not expand on his proposal, however, like whether he would turn down federal money for Iowans enrolled in health care programs like Medicare and Medicaid.

I doubt that Iowans–or anyone else–will seriously contemplate taking the state out of Medicare (as if they could actually do it.) Instead, you'd see people saying "I paid in this [Medicare] all my life and I want what's coming to me."

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

In Iowa, a Field of Schemes

Even though everyone has at least one eye on Washington, DC, some folks are still chasing after a government takeover of health care at the state level.

For example, Iowa Sen. Jack Hatch, D-Des Moines, favors "Medicare for all" on the federal level. But he wants Iowa to take steps to complete a government takeover of health care. He doesn't put it that way, of course; he calls it "making sure that everyone has health insurance," or something like that.

Iowa authorized an expansion of SCHIP during the recently completed legislative session, but did not appropriate any money for it. Perhaps that's one reason why Hatch says putting everyone in an insurance plan is "going to be very expensive. We really can't do that without a federal partner."

The Perfect is the Enemy of the Good

In 91 of Iowa's 117 hospitals, certified registered nurse anesthetists provide chronic pain care. The Iowa Board of Medicine wants to ban the practice.

Does the board want people to suffer? "Board of Medicine legal affairs director Kent Nebel says chronic pain care is a rapidly growing field that requires new scrutiny."

You might rewrite that sentence to read: "Board of Medicine legal affairs director Kent Nebel says chronic pain care is a rapidly growing income opportunity for doctors requires new restrictions on the competition."

The results may be consistent with a belief that we should reserve more work only for doctors. But they may end up hurting patients:

Jim Carney, a lobbyist for the Iowa Association of Nurse Anesthetists, says if only doctors are allowed to administer certain chronic pain treatments, rural Iowans will suffer because fewer doctors are available in rural areas and it's certified registered nurse anesthetists who provide the care for chronic pain.

The Bill that Wasn’t in Iowa

Greg Scandlen had this to say about the recently completed legislative session in Iowa:

The House had been working on a bill that would create an insurance exchange, expand SCHIP, let small businesses buy into the state employee plan, allow the children of illegal immigrants to enroll in public health insurance programs, and ban gifts from Rx companies to physicians.

But these provisions ran into heavy opposition in the state Senate, so the House dropped almost all of it and voted 92 to 3 to approve expanding SCHIP to families at 300 percent of the federal poverty level, but without any funding. It requires parents to enroll their kids in SCHIP if they qualify, but there is no penalty for not doing so. It also created a nine-person panel to recommend how to expand health insurance coverage.

That's generally good news, but the nine-personal panel could be a trojan horse, serving as a rationale for increased government control and less room for free action in health care.

Iowa Poll: Give us the Federal Option

A new poll in Iowa says that residents of that state want the federal government to offer a public option.

From the Des Moines Register:

The Iowa Poll found that 56 percent of Iowans support creation of a public plan. Thirty-seven percent oppose the idea and 7 percent are unsure. If such a plan were created, 47 percent of Iowans who aren't already insured by government programs say they would consider enrolling.

Sen. Charles Grassley, thankfully, understands the risks. At statement released by his office says: "A government-run option might sound good, especially in an environment where jobs are being lost, but Iowans would be better off with insurance market reforms that make coverage available and affordable to everyone."

The state's other senator repeats the myth that government plans have lower overhead (and are sustainable).

For more on this topic, see:

Public option is a stalking horse for a government takeover of your insurance–from the mouth of a single-payer advocate.

Medicaid's historic underpayment of physician fees–not good for getting access to a doctor.

Why government "competition" is inherently unfair.

The failure of a government-run option in Colorado offers lessons.

Advocates of removing your choice have co-opted all the good words.

Where do Insurance Mandates Come From? Industry Interests

A news story from Iowa has a refreshingly honest take on a new mandate, this one involving prosthetics, which will now be required under state law:

"Lobbyists for the prosthetics industry and some lawmakers pushed for this in past years, but were foiled."

Chiropractors lobby to have chiropractic services covered. Christian Science practitioners lobby to have Christian Science services covered. And so it goes.

Say what you will about any particular mandate–criticizing this mandate seems like taking a swipe at Tiny Tim Cratchit–but too often, the shape and content of an insurance policy is not based on what insurance buyers seek, but on what lobbyists and politicians agree upon.