Throughout the United States, high school civics teachers routinely teach that the United States uses a system of government that divides power among national, state and local levels called federalism. In recent years, many states have used this system to address problems that the national government has been unable to fix. From stricter environmental laws to gay marriage, states have been taking the lead and deciding for themselves how they want to proceed. Now, a number of states are taking on the issue of health care, a heavyweight in the political arena.
The state that has been garnering the most attention on this issue has been Massachusetts. The Massachusetts health care plan mandates that everyone in the state must have some form of health insurance. To help the poor, the state will pay subsidies to the uninsured to help them purchase an insurance policy. Whereas in the past the state reimbursed hospitals for the cost of treating the uninsured, the state will now pay the uninsured to get insurance plans instead. In addition, a state program called the "Connector" will bring health plans from insurers together for consumers to compare. Essentially, the Connector will operate as an easily navigable marketplace for insurance plans from many different companies.
One of the big advantages of the Massachusetts plan is that the insurance requirement is very flexible. Already existing employer-based plans fulfill the requirement. Furthermore, the Heritage Foundation report on the plan points out that those who wish to save money and are young or at low risk of medical problems, can fulfill the requirement with high-deductible catastrophic plans that cost less than traditional full coverage plans.
Beyond the insurance mandate, the Massachusetts plan also lessens some of the unique and extensive Massachusetts regulations on insurance plans and providers. Questions remain over whether the mandatory insurance plan can be applied to other states that have a higher rate of uninsured citizens, yet there is no question that Massachusetts has taken the lead in attempting to reform health care.
Recently, our state has also been active in the area of health care reform. In June, lawmakers in the Wisconsin Senate passed a radical health care reform act that would transform the way health care is currently procured. This act, entitled "Healthy Wisconsin," changes health care from an employer-based platform to a state-based platform. In lieu of health care premiums, businesses will instead pay a tax of around 10 percent on their employee payroll to the state. Employees will pay an additional 4 percent tax on their wages. After these funds are collected, the state will then distribute health insurance premium credits based on income and family status.
Instead of negotiating with businesses and individuals, health insurance companies will offer bids on a per person cost basis for different plans that are put together by the Healthy Wisconsin Board of Trustees. Wisconsin residents can then purchase their insurance plan through a Wisconsin Health Network and choose one of the more comprehensive plans and pay the difference in price. Some of the hallmarks of the plan include free preventive care visits, as well as the ability to transfer your plan from job to job.
Although all of this sounds nice on paper, there are some big drawbacks surrounding the current plan. First, the governing Board of Trustees seems to have been developed to specifically cater to special interests. According to a summary sheet from the progressive group Institute for One Wisconsin, the board would be composed of four members from state labor organizations, four members from state business organizations, one member from statewide teacher labor organizations, and two members of statewide farm organizations. Beyond the obvious special interest pandering that will ensue here, the funny thing about this list of members is that it doesn't include any members of the medical community. They are relegated to an advisory committee for the board without any decision-making powers.
Secondly, unlike the Massachusetts plan, Healthy Wisconsin in effect does not allow citizens to look outside the state-run insurance process for coverage. The formation of this public-private monopoly on health insurance takes away an individual's ability to choose. According to Rep. Leah Vukmir, R-Wauwatosa, beyond merely determining the composition of benefit plans, the board will also regulate insurance companies and be in charge of adjusting the tax rate to ensure revenue into the system. To coordinate all of these powers, the Board of Trustees will undoubtedly require a large number of employees to run and regulate the plan. In my opinion, the extensive power of this board leaves it susceptible to corruption and bloating.
The system of federalism in the United States allows for states to experiment with new and different ideas. However, history provides plenty of examples of how once a government program begins, it is almost impossible to kill in the future and invariably expands in scope and cost far beyond its original intent. Take for example the Defense Department or the Social Security system. Although I applaud the pioneering nature of the Healthy Wisconsin plan, the radical restructuring of the insurance system brings too many risks to leap into. Instead, Wisconsin should more closely observe the Massachusetts plan and look for less radical solutions that leave the maximum number of choices in the hands of citizens.
Andrew Wagner ([email protected]) is a junior majoring in computer science and political science.
