PFB Blog

State Health Reform a Model for…Federal Government?

By PrivatePigg ~ October 12th, 2009. Filed under: Uncategorized.

What could play a central role reforming the nation’s health care system happens in a small conference room of the Aesculapius Medical Center — two patients learning the basics of managing their diabetes.

The pilot program begun in 2003 aims to reach patients with chronic conditions, keep them healthier and, ultimately, save money by heading off expensive hospitalizations and procedures. Already, emergency room visits are down.

It’s health care at its most basic, but in some ways it’s revolutionary. In a system where private insurers and the government reimburse providers for treating sick patients, the physicians who treat the two diabetes patients will get more if they stay healthy.

Setting aside the debate over whether the program actually works or not (which is a separate post), let’s assume for the sake of argument that it does.

If the State of Vermont has a successful program for improving health care, or lower health care costs, why would that be a model for the federal government? It seems to me that Vermont’s success would be a model for other states.

Consider first that health care at the federal level is unconstitutional. See Article I, Section 8 of the US Constitution. Said section lays out the enumerated powers for the legislature. Then see Amendment X of the US Constitution, which specifically reserves all rights to the States except those specifically granted to the United States.

Now, recognize that the Courts have often used the “general welfare” and “necessary and proper” clauses of Article I, Section 8, to broaden the powers of the United States vis-a-vis the States, but that argument is easily dismissed.

To lay taxes to provide for the general welfare of the United States, that is to say, “to lay taxes for the purpose of providing for the general welfare.” For the laying of taxes is the power, and the general welfare the purpose for which the power is to be exercised. They are not to lay taxes ad libitum for any purpose they please; but only to pay the debts or provide for the welfare of the Union. In like manner, they are not to do anything they please to provide for the general welfare, but only to lay taxes for that purpose.

To consider the latter phrase, not as describing the purpose of the first, but as giving a distinct and independent power to do any act they please, which might be for the good of the Union, would render all the preceding and subsequent enumerations of power completely useless. It would reduce the whole instrument to a single phrase, that of instituting a Congress with power to do whatever would be for the good of the United States; and, as they would be the sole judges of the good or evil, it would be also a power to do whatever evil they please.

It is an established rule of construction where a phrase will bear either of two meanings, to give it that which will allow some meaning to the other parts of the instrument, and not that which would render all the others useless. Certainly no such universal power was meant to be given them. It was intended to lace them up straitly within the enumerated powers, and those without which, as means, these powers could not be carried into effect. It is known that the very power now proposed as a means was rejected as an end by the Convention which formed the Constitution. A proposition was made to them to authorize Congress to open canals, and an amendatory one to empower them to incorporate. But the whole was rejected, and one of the reasons for rejection urged in debate was, that then they would have a power to erect a bank, which would render the great cities, where there were prejudices and jealousies on the subject, adverse to the reception of the Constitution.

2. The second general phrase is, “to make all laws necessary and proper for carrying into execution the enumerated powers.” But they can all be carried into execution without a bank. A bank therefore is not necessary, and consequently not authorized by this phrase. It has been urged that a bank will give great facility or convenience in the collection of taxes. Suppose this were true: yet the Constitution allows only the means which are “necessary,” not those which are merely “convenient” for effecting the enumerated powers.

The words of Thomas Jefferson.

Nothing prevents the individual states from addressing health care, unless they have prohibited it in their own constitutions or by statute. Further, it makes infinitely more sense to allow a state the ability to reform health care, considering the state is a much smaller entity population-wise and size-wise. Do we really think the United States government capable of any top-down solution that would be even remotely fair or responsive to the needs of the people considering a population of 307 million spread out over 10,000,000 square miles, with 50 state governments and an infinite number of different cultures, attitudes, and societal realities? We’ve already seen how slow, bureaucratic, wasteful and inefficient the US government can be. But the State of Iowa could be responsive to its own people, could it not? A smaller group of people with more direct say in their government can expect more locally-tailored and responsive programs and legislation. Problems can be addressed easily and quickly, as most people will be in a similar situation, being Iowans.

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