​The Graham-Cassidy reform-and-perhaps-replace-but-not-really-repeal plan has earned praise from a fair amount of analysts on rightish side of center, and it does indeed use a vigorous federalism as it’s guiding principle, kicking the debate down to the individual state level.

This is really chasing the emerging reality. Texas already delivers health care in ways that are different from New York or California. Graham-Cassidy would give states more room to work out their own solutions by block-granting money that would have gone to Medicaid expansion or premium tax credits under the Affordable Care Act. You want single-payer and high taxes? Move to California. You want affordable premiums and higher-deductible plans that mean you pay more for day to day health care but you’re covered for the larger expenses you may face? But lower taxes and more jobs? Move to Texas.

Their plan is a reasonable solution to what is becoming an unbridgeable gap between Democrats who now increasingly pledge their allegiance to single-payer systems (until they find out what rationing is like when it comes to healhcare) and Republicans who want real choice and real competition in the health insurance market.

Ah, the health INSURANCE market. Yes, insurance industry lobbyists have been a constraint on innovation you might say. But, health CARE is so much more than just insurance premiums. That is not a clarion call for big spending, by the way. It’s merely to point out that a major factor in increasing premiums is often lost in the current debate:

Hospitals in America are producing very high-cost products and services and are a supported by powerful lobbyists that do their share of whispering and bending ears to ensure that innovative competitive solutions do not threaten their cozy, coast-to-coast oligopoly.

One reason for this is the employer-based plans where customers don’t see the true cost and thus the true price of the health services they select. So the big and fat and getting fatter hospital networks can keep raising prices far beyond what almost any other industry is able to get away with. And if money from employer-based plans is not enough to cover the increases, why there’s always the federal government.

So let’s hope that if Graham-Cassidy can get passed into law – and it perhaps just might – then the next step would be to look at freeing up healthcare in America from the welter of self-serving regulations that keep competitors at bay. And maybe the state level is indeed the best place to attempt those types of innovations

Comments