How to Fix American Healthcare: Kick Out Washington

By Deane Waldman, MD MBA - 29/05/20

There are six important reasons to kick Washington OUT of U.S. healthcare. Simply put, healthcare is not in their wheelhouse. The solution to our failing healthcare system is StatesCare, not more-of-the-same Washington domination, called single payer or Medicare-for-All.

Reason #1: Track record

The first and most obvious reason to kick Washington out is its track record. For more than fifty years, the federal government has been fixing healthcare, and look what their "fixes" have produced: needed medical care is both unaffordable and unavailable, especially when we need it.

Imagine a football team that has had the same coach for fifty seasons and lost every game. Would you renew that coach's contract for next season?

Reason #2: Cost

In 2009, President Obama said spending on U.S. healthcare was "unsustainable," and he was correct. In 2010, the year the Affordable Care Act (ACA) was passed, the U.S. spent $2.5 trillion, 16 percent of GDP, on healthcare. The ACA was implemented starting in 2014 at a cost of $1.76 trillion. By 2018, we were spending $3.6 trillion on healthcare, 19 percent of GDP.

Washington's latest self-proclaimed cost-cutting effort, the ACA, dramatically increased spending on healthcare. What was unsustainable in 2010 has become even less sustainable due to Obama's namesake legislation. Americans need to find some way to reduce spending on healthcare that doesn't depend on Washington.

Reason #3: Cost/Benefit

When an American considers purchasing anything, a product such as a sweater or a service like dry cleaning the sweater, the buyer compares money spent with benefit received. We know how much we are spending on healthcare. Are we getting an appropriate benefit? The answer is an emphatic no!

Nationally, we spent $3.6 trillion on healthcare in 2018, approximately twice what other developed nations spend. Yet wait times to see a physician increased to a point where people die waiting in line for medically possible, life-saving care that isn't available in time. Such "death-by-queueing" has been reported in Maryland, Illinois, and the Veterans Administration health system.

In 2018, the average American family expended $28,166 on healthcare costs, of which $23, 462 (83 percent) was paid to insurance companies. As median gross family income in 2018 was $63,179, a healthy family of four wasted 45 percent of their total compensation. (Imagine if they could have put all that money in to a family HSA.)

With Washington in charge of healthcare, Americans are spending more and getting less-a truly terrible cost/benefit ratio.

Reason #4: Legal

The original 1965 Medicaid law created "jointly funded, state administered" programs. Note the phrase state administered. Over five decades, the federal government has gradually taken control of every aspect of all Medicaid programs from eligibility and verification to mandated benefits and payment schedules.

In fact, the Medicaid law also explicitly legislates local, i.e., state, control of each program. Section 1801 of the Medicaid law is titled, "Prohibition against any federal interference."

Reason #5: Constitutional

The Tenth Amendment to the Constitution reads as follows: "The powers not delegated to the United States [the federal government] are reserved to the States respectively, or to the people." Since healthcare is not a "power" explicitly granted to Washington, control should reside with "the States ... or ... the people."

When Congress dictates our health and its care, federal politicians take authority to themselves that the Constitution specifically denies them.

"StatesCare"

Washington has been in charge of healthcare for so long that few Americans can envision a healthcare system without federal control. My grandfather practiced medicine on his patients without federal bureaucrats telling him what to do and how much (little) he would be paid for his efforts.

If we kick Washington out of healthcare, who then controls healthcare, and what happens to the money currently expended on federal healthcare bureaucracy?

First, the money. A minimum estimate for spending on healthcare bureaucracy, not patient care, is 31 percent of healthcare spending, or $1.1 trillion in 2018. By removing Washington from healthcare, the American public could recoup more than one trillion hard-earned tax dollars to (a) spend on patient care or (b) keep in their pockets.

Reason #6: Practical

Another reason to kick out Washington is practical. The federal one-size-fits-all approach is ridiculous, especially when applied to 326,700,000 widely diverse Americans spread out over 3,531,905 square miles, 30 percent more land mass than the Australian subcontinent.

Montana and Rhode Island have similar population sizes, 909,453 and 1,070,000 respectively. Rhode Island has 5500 physicians within 1212 square miles and three world-famous medical centers within 45 minutes' drive of Providence, RI. Montana has 1100 physicians serving people spread over 145,000 square miles. The closest major trauma center to the state capitol, Helena, is in Salt Lake City, Utah, eight hours' drive assuming roads are passable.

Healthcare needs, resources, and limitations are very different in the two states, yet Washington applies the same rules and regulations to both.

If Washington were removed from healthcare, who would be in charge? Answer: the American people in their states or groups of states. With 39 million residents, California has two million more people than in all of Canada. If Canada is allowed to have its own, unique healthcare system, so too California should be free to choose.

Giving Americans within their states the right to choose their healthcare is called StatesCare.?

Californians seem to want a single payer structure. Texas, the second most populous state with 29 million residents, may desire a market-based healthcare system. Oregon (4.2 million) claims to want universal healthcare, and Massachusetts (6.9 million) appears to like their version of the ACA. Who is Washington to take away the freedom of 79 million Americans?

By kicking Washington out of healthcare and implementing StatesCare, Americans can have they want: the healthcare system(s) of their choosing and medical care at a price they can afford.