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Federalism and U.S. Health Care

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On 1/17/14 Avik Roy of The Manhattan Institute wrote an article, “A conservative case for universal coverage.” He discusses two health care plans from Singapore and Switzerland that are currently working.

With the Singapore plan, everyone has a health savings account that is financed by an employer paid payroll tax. Individuals then use these accounts to pay for their routine medical care. This is similar to out-of-pocket payments in the U.S. The government picks up the tab for catastrophic illnesses.

With the Swiss plan, there is a mandate that people purchase health care insurance that is subsidized on a sliding scale depending on one’s income.

Roy then discusses how we can modify ObamaCare using the best ideas of these two plans. He says this will give us high quality, affordable, universal health care. He concludes that it will also give us, “a fiscally sound country.”

To accomplish this, Roy says that conservatives, “must make one change to their stance: They have to agree that universal coverage is a morally worthy goal.” I think that most conservatives would agree that it is a morally worthy goal for everyone to have needed health care.

He uses the example that, “No conservative politicians oppose universal public education.” Perhaps most do not but there is a growing movement to remove the national government from controlling our children’s education, especially when it comes to “common core.” This started with President Reagan in 1981.

Roy is correct that most politicians do not oppose universal public education, but he is incorrect to imply that it should be done at the national level. Our country was founded on the principle of federalism. The federal government would have limited powers while the states would have many powers.

This system protects our country from bad ideas, although individual states may have to endure them until they come to their senses. James Madison explained this in the Tenth Federalist Paper:

The influence of factious leaders may kindle a flame within their particular States, but will be unable to spread a general conflagration through the other States. A religious sect may degenerate into a political faction in a part of the Confederacy; but the variety of sects dispersed over the entire face of it must secure the national councils against any danger from that source. A rage for paper money, for an abolition of debts, for an equal division of property, or for any other improper or wicked project, will be less apt to pervade the whole body of the Union than a particular member of it;

The combined populations of Singapore and Switzerland are about that of Illinois. If Mr. Roy is a conservative who advocates our founding principle of federalism, he should advocate his plan at the state level rather than nationally.

Conservatives should advocate for our national government to eliminate any tax subsidy to the crony capitalism of job-based health insurance. It should turn Medicare and Medicaid over to the states. If this was done, some states could try the Singapore or Swiss Plan. Others could try Mr. Roy’s combination plan while still others might try a free market plan.



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