There have been many efforts throughout time to make major changes in the laws of this country and the culture of its people in a short amount of time. I have found none that succeeded. Laws relating to civil rights, labor and workplace safety, environmental, and income taxes all took decades to come to fruition. They were all step by step processes.
Even the stock market crash of 1929 and the Great Depression were not enough to cause immediate passage of securities laws. It took ten years for all of the laws that are the foundation of today’s markets to be put in place. Ten years is extraordinarily fast for our government to make such sweeping changes.
Little victories laid the foundation (see the NEPA in 1969). An obvious and easy fix came next (see the Clean Air and Clean Water Acts of the early 1970s). The idea that cleaning the environment was important and that the government must lead the way became the norm rather than the other way around. RCRA, FIFRA, NRC, CERCLA, LUST and many others were passed, re-authorized and strengthened under both Republican and Democratic presidencies over the next 20 years until the framework of today’s environmental laws and culture were firmly in place. The last major environmental law was passed in the late 1980s.
Today the government is dealing with carbon emissions. The question is no longer whether this is the realm of the government. The questions surround whether carbon is really an environmental problem and if so, what are the ramifications.
So looking at history and reality, this government needs to look at healthcare as a long term incremental process.
Step one has got to be the establishment of the federal government as the source of healthcare regulation. Pass a first law that simply states that national healthcare and health insurance will be regulated across state boundaries by the US Department of Health and Human Services and that the States are now preempted from regulating healthcare, unless the insurance company or provider has absolutely no inter-state or federal involvement (no patients from out of state, no Medicare or Medicaid reimbursements, etc.).
Republicans favor this as it opens competition across the entire country, allows smaller creative carriers to get into the game, and eliminates the costly state-by-state compliance. Democrats should favor this because it gets the federal government in the game. This is critical if a government run plan is ever going to fly.
Step two will be to mirror the idea of the government option, by allowing associations to buy group priced insurance across the country for their members, whether they are companies, union workers or covered by the United Way. In the process, allow people to buy into the US government workers group plan if they want. This also spurs competition, which Republicans should like, allows commercial creativity and gets the federal government into the healthcare providing game.
Combine Medicare, Medicaid, Veterans benefits, US employee and military benefits under one umbrella and provide these as one. Take this out of the hands of the States and make it uniform across the country. Gain experience, eliminate red-tape, increase efficiencies, lower costs, compete and show that the federal government can do this extremely well.
If it makes sense, it is then a fairly easy next set of steps over time to add regulation and coverages provided by the government for catastrophic cases that go over a certain limit, cases that require experimental treatments, cases where the patient is permanently disabled, and high risk cases where malpractice is a big concern for practitioners. Take the step that begs for attention.
Finally, twenty years from now, universal government provided healthcare, IF it is still required to provide adequate coverage for Americans who want it.
There is an old saying, those who fail to heed the experiences of history are bound to repeat them. In this case, we should repeat what history shows us is the right way to make major sweeping changes.
