On the thinnest layer of the surface of the Graham-Cassidy Obamacare replacement bill, one can make a case that this is an example of federalism. Once you peel back the first layer, it’s clear that this is an attempt to justify federal government overreach by slapping on the federalist stamp of approval.
As Federalists, we do not approve.
First, let’s get the biggest argument in favor of the bill out of the way. Yes, this bill is better than Obamacare, but only marginally so and with a caveat. It’s better because it removes the individual and employer mandates. It’s better because it defunds Planned Parenthood. It’s better because it removes the tax on medical equipment.
What about the “federalist” components? Block grants replace Medicaid expansion, so that’s federalism, right? States are given more power over waivers, so that’s federalism as well, right? Wrong and wrong. By giving states block grants, all they’re doing is taking the same source (federal tax dollars) and the same recipients (insurance companies) and inserting a middle man (the states). This part is false federalism. It’s a component that doesn’t represent true federalism, but it tries to play that role in this bill.
What about the waivers? Here’s the problem. There should be no need for waivers from a federal health insurance program because there should be no federal health insurance program. Taking these waivers and calling it federalism is like having a thief break into your house and calling him generous because he didn’t steal all of your possessions.
I went into greater detail about why this is a bad bill already so I’m not going to rehash it. Instead, let’s talk about chicken and steak. In this analogy, chicken is government-operated health care and steak is true free-market healthcare that embraces competition, consumers with choices so they can drive down costs, and states as the direct support system rather than the middle man through federal grants. Obamacare is raw chicken. You shouldn’t eat it. If you touch it, you should wash your hands before touching anything else. A proper repeal and replacement bill would systematically ween the nation from federal government-operated health care as quickly as reasonably possible. That’s the steak and in this analogy we’re calling it medium rare (federalism) because that’s how I like mine cooked.
True federalism is not an ideology. It’s a structured system through which ideologies are allowed to fight on the proper levels. It’s shared responsibilities between multiple government entities whose powers are restrained within concrete guidelines. For America, those guidelines are the Constitution. That’s why in my analogy federalism isn’t the steak. The free-market economy operating our healthcare system would be the steak. Federalism is simply how it’s cooked. Making it medium rare in a true federalist way would be to embrace consumer-driven competition while allowing the states to decide how to properly implement necessary safety nets when needed.
Neither Obamacare nor Graham-Cassidy allow American federalism to work because both require the federal government to have degrees of control over an issue that should not fall to the federal government at all. Healthcare is reserved to the states and individuals. Both Obamacare and Graham-Cassidy are chickens. The only difference is that Obamacare is raw while Graham-Cassidy is cooked a little. It’s still undercooked and therefore dangerous. Instead of acknowledging the dangers, they’re serving it as-is and saying it’s medium rare. You can eat medium rare steak. There’s no such thing as medium rare chicken.
There’s also no such thing as a national healthcare plan that embraces federalism even if some of its components resemble federalism.
Finally, let’s discuss the caveat mentioned above. The math is wrong in Graham-Cassidy. It’s great that it removes the mandates, but by keeping elements such as preexisting conditions, they are forcing the insurance companies to raise premiums to compensate for the lost customers. You can’t remove the mandate and keep the stipulations without making premiums rise. Isn’t the argument that Republicans have made for seven years that Obamacare made premiums and deductibles rise while reducing the quality of healthcare itself? Guess what. Graham-Cassidy will not solve this problem. In fact, it will make it worse.
America needs a plan that removes the economic burden of Obamacare as well as DC’s socialist-leanings on healthcare. We need a bill that says federal-operated healthcare doesn’t work and we’re going to remove DC from the equation altogether over the next X years. DC-run healthcare will lead to single-payer. Calls for it will increase faster than insurance premiums (which will rise quickly). We need DC out of the healthcare business and Graham-Cassidy does the exact opposite. It plants DC in the middle of healthcare indefinitely.