Health care

A doctor’s straight talk: America, your health care is not a federal responsibility

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FILE --  (iStock)

There are a host of good reasons to “repeal” the Affordable Care Act (ObamaCare). “Replace” is an entirely different matter. Start with its negative effects on individuals and on our country.

Americans are experiencing skyrocketing health insurance costs—premiums, co-pays, and deductibles—which is the opposite of what the law’s name promised: affordable. The ACA is wasting trillions of dollars even though President Obama initiated his takeover of health care claiming we had to “bend down the [health care] spending curve.”

Supporters of President Obama’s signature law loudly tout its one success—an increase in the number of insured Americans. Regrettably, it did so by reducing access to medical care for all Americans.

The ACA cut reimbursements to Medicare providers by $716 billion. States that expanded Medicaid under the ACA, such as New Mexico, were forced to cut the already low payment schedules to Medicaid doctors even lower. Cuts to physician reimbursements automatically reduce the availability of physicians. As Robert Moffitt of Heritage Foundation testified before Congress in 2009, “You can’t get more of something by paying less for it.”

More insured patients plus fewer available doctors equals longer and longer wait times. That is why 752 residents of President Obama’s home state of Illinois died: they had to wait too long to get life-saving care that was not available in time. This is called death by queueing, something U.S. veterans experience every day.

ObamaCare has aided the growth of the malignancy that is destroying U.S. health care: a massive federal administrative apparatus and regulatory machine that diverts trillions—not millions or even billions—of “health care” dollars away from health care services to pay itself, to pay the health care bureaucracy.

There is another, even more compelling, reason to repeal ObamaCare. Health care is not the fed’s job! Providing health care is not a federal responsibility according to the U.S. Constitution and the Medicaid law.

The Tenth Amendment to the U.S. Constitution reads, “The powers not delegated to the United States [the federal government] … are reserved to the States respectively, or to the people.” As the Constitution does not grant control of health care to Washington, health care should be “reserved to the States.”

The original 1965 Medicaid law created a “jointly funded, state administered” program. Note the phrase state administered. Over five decades, the federal government has gradually taken control of every aspect of supposedly state-run Medicaid programs. Not only should the states control health care within their borders according to the Constitution, but the Medicaid law also explicitly legislated local, i.e., state, control of each program.

The problems of health care delivery in Texas are not the same as those in Connecticut or in Oregon. Every management expert will tell you that the lower down in the power structure you put decision-making authority, the more responsive, more effective, and more efficient an organization or a system like health care will be. Local control always achieves better outcomes than a distant centralized, one-size-fits-all approach.

Who has a better understanding of the health care needs of people in South Texas: a federal bureaucrat sitting in a cubicle at 200 Independence Avenue, Washington, D.C. (headquarters of the Centers for Medicare and Medicaid Services) or the state representative from South Texas and the voters in Hidalgo county?

If Congress repeals ObamaCare, what should they replace it with? That is the hot question-of-the-moment. There is a one-word answer.

What should Congress replace ObamaCare with? Nothing! I write again, Nothing!

Let the states decide how best to care for their people. Let the states organize health care activities within their borders and make whatever deals they like across borderlines.

Finally, should Washington continue to provide health care funding if the states control their health care? That is another story, a big one that requires more elaboration than the remaining word limit for this article allows. Stay tuned.  

Dr. Deane Waldman, MD MBA, is Emeritus Professor of Pediatrics, Pathology and Decision Science, and Director of the Center for Health Care Policy at the Texas Public Policy Foundation as well as the author of The Cancer in the American Healthcare System. He can be reached at dwaldman@texaspolicy.com.