February 1, 2012
As originally published in the New Hampshire Union Leader
MOST PROPOSALS on health care are part of a highly charged ideological debate. One exception this year, the health care compact, is not a short-term solution but a longer-term project that will allow New Hampshire to benefit by letting other states craft proposals on the right and the left.
A health care compact is a proposal in the Legislature to have New Hampshire join with other states (four have already passed the compact language) to petition the federal government to grant states the authority to take federal health care spending in their state and craft their own program as a replacement for the federal program.
This is not some wacky theory like nullification, but rather states coming together and asking Congress to vote to give states an option. One option would be to stay in whatever system is created by reforms in Medicare and Medicaid.
Another option would be for an individual state to create its own reform. Very few states will undertake their own reforms, but we could all benefit from giving those few states that option.
We know that change is coming to the biggest federal health care programs. Rep. Paul Ryan, the leading conservative on health care issues, and Sen.
Ron Wyden, one of the leading liberals on health care issues, have put forth a compromise proposal. The merits of the proposal don’t matter for this discussion. When the leading liberal and leading conservative on health care both agree that change is coming — amid a half dozen other proposals floating around Washington — we know change is coming.
A health care compact would let states, if Congress agreed, craft their own experiments instead of accept whatever new federal proposal emerges in the next few years. Some states will do things that I support, others will do things that different people support and then we’ll see how each works.
At a hearing on the compact, Rep. Gary Richardson asked me what I actually wanted to see happen. The implication is that I have an end game in mind and want the federal government to let us make that happen in New Hampshire.
What I really want is for New Hampshire to wait. I want us to petition the federal government to give states authority if they choose and then wait and see what other states do. Even though all 50 states would be granted the choice by Congress, only six or eight would exercise that choice, but each of those states would amount to a pilot program — and very different pilot programs that should teach us something.
“Laboratories of democracy” has become one of the most hackneyed phrases in American politics, but Louis Brandeis’ original thought is at the heart of a health care compact.
Brandeis said “one of the happy incidents of the federal system is that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”
I don’t think New Hampshire is currently up to the task of coming up with useful reform but other states are. Texas would probably try something more market-oriented, Vermont would almost certainly create a single-payer plan and become a teeny version of Canada.
I think Vermont or Oregon or whoever tried single payer would prove it a failure, but it is possible that I’m wrong (unlikely, to be sure, but within the realm of possibility). On the other hand, the New Hampshire way is to watch carefully what other states do and then import the best pieces into our system. Allowing other states to pilot innovative programs, only if they choose to do so, will help us all.
Some will object that nothing in a compact prevents states from doing something stupid.
But that’s just the point. We want to allow states to craft their own pilot programs with as much latitude as possible. They should use their judgment to replace Washington’s. And New Hampshire should watch the results to reap the benefits.
Make no mistake, this is a long-term, cautious project. It won’t go before Congress until many states have joined together to ask. Even then, it will require debate and congressional approval. Even at that point, New Hampshire should let other states lead the way and watch cautiously. But their pilot programs will teach us lessons and teach the federal government lessons. This is a health care proposal that doesn’t presuppose a program or an ideology. It will be a tool for liberals and conservatives alike. The longterm future of health care will demand more than just yes or no answers to the question of the month. We should put other states to work for us.