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  • New County Health Study Reinforces Need for Federalism in Health Reform

    The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute just released a new report that exposes the diversity of health care across the country on a county-by-county basis. What’s striking about the interactive report is the high level of variance found in health care for counties within a single state.

    For example, Montgomery and Howard counties ranked in the top slots in Maryland while Baltimore City and Allegany County trailed at the bottom. “In health care, one size does not fit all,” said Dr. Donald Shell, the health officer for the Prince George’s County Health Department, during a discussion of the report findings.

    No truer words could be spoken. However, Congress has been trying to enact a one-size-fits-all measure for the past year with Obamacare, which would indiscriminately impose nationalized health requirements on counties. As Heritage health policy expert Stuart Butler has noted, Congress should be examining modest adjustments to the health care system and allowing states to take the lead in experimenting with new reform models:

    History shows that changing even seemingly minor features of legislation or administrative decision making with regard to health care can have major — and sometimes unintended — consequences for the systems evolution.

    Taking even small steps to improve coverage, it turns out, involves decisions that could have profound effects on the future of the U.S. health care system. Thus, it would be unwise to try to rush through a scaled-back bill on the assumption that minor changes do not require careful scrutiny. It is important to take the time to think through the implications of any new legislation.

    Butler along with analysts within Heritage’s Center for Health Policy Studies has long advocated the need for genuine reform of America’s health care system. But that approach must be state-based to determine what works best in the intricate and complex workings of the U.S. health care sector. Nevada state officials will have a better idea of what residents in Lander County (ranked 14th in the state) need over those in neighboring Pershing County (ranked second).

    States must have the tools and flexibility from Congress to test their ideas and find out what reforms work best or need to be changed. That won’t happen with the Obama Administration’s current health care agenda, especially in light of the upcoming Health Care Summit. The new report should serve as a wake-up call to Congress and the Obama Administration — trying to create a one-size-fits-all health care system is harder than it looks.

    Posted in Obamacare [slideshow_deploy]

    18 Responses to New County Health Study Reinforces Need for Federalism in Health Reform

    1. mac says:

      One size fits all,I think is a characteristic of Socialism as well as other collective notions. t is a lot like one size fits all clothes.

    2. Ozzy6900, CT says:

      But this is all the Federal Government would be able to do, create a Federal Health Care Insurance System. There is no way to tailor a Federal Health Insurance Care System to individual State's needs because a Federal Health Care Insurance System, as we have seen, is very difficult to bring together, so the only way to do it would be "one size fits all". Which is exactly why the Federal Government should stay out of the Health Care Insurance Business!

      States could handle this all by themselves and the Federal Government could help by removing the restrictions that do not allow insurance companies to operate out of state. That would then give the Federal Government all the time it needs to reform Tort! These two things would make so much easier for States to work on bringing Health Care Reform around and it can be done without mandating, fining and imprisoning people, too! All the States have to do deal with people who do not have any health care insurance and leave people who do have health insurance alone.

      How is this done? If you need or want State Health Insurance, you apply to the State. If you have no insurance, the State could refer you to a list of insurance companies that they deal with and you will be insured. Notice that the State is not the nanny here because they hook up with private insurance companies who make the final deal. The State puts in its side of the payment and the insured puts up his/her side. Notice that this is not a "hand out but a hand up". And this is another thing that the Federal Government is not able to do – only pay a portion, not the whole thing!

      Here in CT, if you need to put your child in Daycare but do not have the means to pay for it all, the State helps you out. They pay a share and so do you (my wife runs a Daycare so I know how this works). The system works pretty well as the State pays once a month and the client pays each week. Maybe the same could be applied to Health Insurance?

    3. Eric, Binghamton, NY says:

      As always, I appreciate the perspective brought by the Foundation to these issues. I listened to a local report (from basically a mouthpiece radio station for Cornell U) about this report and was somewhat bemused by their spin.

      In a nutshell the reporting inferred / stated that the disparity in health care by county is directly linked to affluence and therefore education. The very thinly veiled inference was the "rich" are selfish and the "poor" are stupid…. therefore; government needs to take charge.

      I strongly urge the Heritage Foundation to start a radio program that airs for 30 minutes to 1 hour per day to give us the facts as seen through an American perspective. (even 5 minutes in a Paul Harvey kind of way would be Great)

      Thank You Ms Higgins!

      Keep up the Great work Heritage!



    4. J.C. Hughes, Texas says:

      You said it Marguerite, healthcare reform is purely a state issue. Not a federal one.Period!

    5. Ric, Lawton OK says:

      Recently, as part of the coverage for the upcoming "bipartisan" HC summit there has been multiple reports in the NYT, Fox, the Politico, etc that the retiring Republican Senator from NH has proposed yet another verision of the rejected ObamaCare/RomneyCare compulsary insurance scheme!

      I did some research today to find out what where the details of this so-called "compromise" plan.

      Well, Gregg’s compulsary Health Insurance plan wasnt hard to find – it was on his WWW site.

      Its basically a 100% ObamaCare plan that gives the left the key items it desires right now (ie the individual mandate and government control of HC). Essentially, it just tinkers a bit with the amount of government-dictated insurance that people will be forced to buy and how many citizens will become government welfare cases thru subsidies:


      These are the key quotes right from his posted plan!:

      “ENSURING ACCESS FOR ALL AMERICANS: In order to ensure that every American has quality, affordable coverage, the proposal requires proof of health insurance for every American over age 18 and requires insurers to offer coverage to all applicants, regardless of health status.

      TARGETED SUBSIDIES FOR THOSE MOST IN NEED: The proposal includes direct subsidies for low-income individuals for the purchase of a low-premium major medical health insurance plan – subsidies for both the premium and deductible on a sliding scale up to 300% of the Federal Poverty Level (FPL).”

      Yep, this is handing the left and Obama everything they want. ALL compulsary insurance plans are government run HC with a "private" facade – ReidCare, NancyCare, RomneyCare, DringoCare, and ObamaCare are centered around forcing individuals to buy Health Insurance thats essentially dictated by politicans and technocrats.

      Their is nothing left that is "private" or "individual" in any sense of the term! The Federal government runs everything thru regulation and tax subsidies! Its not private or a a free market – it just puts a fake front on the whole take over so there is a good "talking point" to make people who dont have time to deconstruct the whole takeover feel better and to fool them into thinking they arent getting government run HC that will soon implode into a full-blown single-payer system.

      The "Gregg Plan" is the same as ALL compulsary insurance schemes like RomneyCare, Wyden-Bennett, ReidCare, or ObamaCare:

      (a) Federal Government Regulatory power over all Health Insurance companies/Comparative Effectiveness Boards aka HEALTH EXCHANGE CZAR/DEATH PANELS

      (b) Employer/Individual Mandates to force everyone to buy a government specified Health Insurance plan AKA UNIVERSAL COVERAGE

      (c) Massive Government Subsidies to middle class citizens to purchase the mandates insurance AKA MEDICAL WELFARE FOR THE MIDDLE CLASS

      With the Federal Government setting the rules, forcing everyone to participate, and is paying the bills for most of the middle class through subsidies how is this anything other than Nationalization?

      Basically, the Federal government will be controlling the Health Insurance industry just like it controls the Banks and Auto Companies who received bailout money. While it will still technically be true that health insurance companies are "private" companies, they will be only in the same sense that GM, CITIGROUP, etc are still "private" companies. Since the Federal government has provided most of the funding and dictated all the terms of business, politicians and technocrats will really be calling the shots. Essentially, all health insurance companies in the country will be quasi-governmental agencies that simply get to stay in business to administer the National Health insurance program on a small for-profit basis.

      There is no real world difference between a Canadian style govt Single payer and a Compulsary Insurance scheme where the goverment still runs everything thru a very small number of nominally "private" insurance firms (again, the fantasy that any of the few remaining insurance firms will be "private" is a PR facade for politicans – essentially they are govt medical welfare contractors as there business practices are dictated to them by government technocrats and they will be wholly dependent on taxpayer subsidies to stay in business) where the the technocrats run medical care/insurance thru regulation and pay the bills for nearly everyone in the country with taxpayer funds.

      Again, are Republicans/conservatives really this stupid to think this form of government intervention is NOT EXACTLY what the left wants (ie Federal Government Control)? Or more to the point, do they really think WE THE PEOPLE are this stupid that we would be so easily fooled or lied to like this?

      What makes this particularly bad is that Senator Gregg has gone on record voting against Individual Mandates as being Unocnstitutional in DEC, yet he has to gall to post a plan on his WWW site a bit over a month later advocating/centerd on Individual Mandates to force people to buy "private" insurance!

      So I guess Gregg, since he is not seeking reelection, has been selected by the Republican establishment to be the new Specter and sell the American people out to the left and the “big” insurance lobby and other interests!

      The American Peole have won the battle FOR the Republicans and our supposedly "conservative" elected officials in the DC establishment are actively working to throw it away!

      The word needs to get out to all true Conservatives and other Patriots NOW about this danger or the supposed "HC summit" will essentially become a televised celebration of the impending passage of ObamaCare!

      Please help push the word out on this to all who oppose Government Run Health Care before its too late!

    6. Mark Rubler, Amston, says:

      If we learned anything at all during the Clinton era healthcare reform efforts was this – healthcare is local. As a Healthcare Executive in New Mexico, Okalhoma, and Kansas, I can tell you first hand that what worked in Albuquerque did not work in Oklahoma City and certainly not in Hays Kansas. Each area's needs were unique and presented equally unique challages to the entire healthcare delivery system.

      Expectations that a single entity, govermental or otherwise, can address the disparate healthcare needs of this country are unreasonable.

    7. DAVID LA ROCHELLE, M says:



    8. Les Stewart, South C says:

      The major problem with letting health insurance companies to operate in multiple states is not with Congress. The problem is that the insurance companies do not want to compete! They have it made now where two or three companies control 90 to 95 percent of the health insurance in each state. If your business had all the work it could handle with no competition would you want to have a couple hundred companies turned loose in your state?

    9. Judge G W Jefferson says:

      No government entity, federal or state, has the authority to reform any private enterprise including the insurance industry. Individuals and corporations have rights to contract as they please. The 5th.and 14th Amendments liberty clauses protect private contract rights against infringement by the federal government and state governments.The Supreme Court has so stated. Also, Article 1, section 10 of the Constitution prohibits a state from infringement of contract rights.

      The only way the federal government can interfere with the health care industry is under the authority of Congress to regulate interstate commerce. That they lack the present authority to do because the US Code – Title15 USC Sect.1011-12 (the McCarran Act (1945) authorized state regulation and taxation of the insurance industry negating a prior Supreme Court case, U.S. v. So. Eastern Underwriters Assn., 332 U.S. 533 (1944). That case had held insurance transactions across state lines subject to interstate commerce and immune from discriminatory state taxation. South Carolina had taxed the premiums of out-of-state insurance companies but not instate. Those who think interstate insurance transaction would be less expensive would be asking for more trouble than expected by having Congress exercise its constitutional authority to regulate interstate commerce.

      Judge G W Jefferson (Ret.)

      Columbia, SC

    10. Don Harper, Lubbock, says:

      Once one understands that the the Democrats' "healthcare" proposals are not about healthcare at all, but rather about increasing their own power and control over the people, it becomes much easier to understand their seemingly irrational refusal to accept any ideas that will actually improve our healthcare systems. It is past time to send all these cockroaches scurrying back home. We need programs like "Let's just call her 'Barbara' ", for about 90% of Congress.

    11. ChuckL,NV says:

      The Federalism should be kept to the availability of information and records, but never used to prescribe actual care standards. Suggested care standards are acceptable but must never be given the status of mandatory.

    12. Drew Page, IL says:

      Yes, the Republicans should accept the invitation to participate in the "bipartisan" debate on HCR, but only if they come to this meeting with their own version of HCR. Their version should be detailed and drafted in the form of a bill, ready for submission to the House and have cost estimates prepared by the Congressional Budget Office. If they don't have their own version of HCR, explained in detail, with cost estimates and ready for submission to the House, the Democrats will say the Republicans don't have a plan of their own and merely want to be obstructionists.

      The Democrats have been working on separate versions of HCR in the House and Senate for over a year. They have rejected amendments, calling for Tort Reform, submitted by Republicans, to the legislation that they wrote. They would not include include Republican suggestions to allow citizens to purchase individual health policies from out-of-state insurance companies; nor would the Democrats include Republican suggestions that would require all Federal employees, including members of Congress, to be covered under the same national health plans which they tried to push off on the rest of us. The Congressional Democrats have worked on an HCR bill for over a year, excluded input from Republicans, and couldn't sell it to all the Democrats, nor could they sell their version to the Senate. In the Senate, the Democrats also worked on a bill over a twelve month period, excluded input from the Republicans, had to buy the votes of the Senators from Nebraska and Louisiana with hundreds of millions of taxpayer dollars. Up until this February, they had a 60 vote supermajority and still couldn't sell their version to all of their own Senators.

      The Democrats have had it all their own way for the past year and even with their controlling majorities in the House and Senate couldn't get the legislation passed. Unbelieveably, they are blaming the Republicans for their failures to pass their versions of HCR.

      The public has become more educated educated on the various provisions of the House and Senate versions of HCR. They have learned who will be exempted from it, how it will be paid for, who will be taxed on the value of "Cadillac" health plans and who will be exempt from those taxes, the majority of legal voters don't want it.

      And only now that they majority of public opinion has turned against the Democrat versions of HCR does Mr. Obama want to invite the Republicans to

      join in a "bipartisan" discussion on C-SPAN. Why weren't all those closed oor meetings among Democrats in the House and Senate put on C-SPAN like Mr. Obama promised at least 20 different times during his campaign???

      Pardon my skepticism, but I think the only reason Republicans are being invited to discuss HCR is to say yes or no to the Democrat plan that has already failed, so that the Democrats can once again call Republicans the "Party of NO". If the Republicans don't have specific HCR plans of their own, they had better be prepared to say "OK, we will the support the HCR legislation provided all of the following provisions are removed and the following provisions are added. Then let the Dems be shown as the "Party of NO"..

    13. Louis Levy Houston T says:

      It is certain that Federalism, the Democratic system by excellence cannot forget how reality is diverse and how this diversity produce a singular laboratory where ideas and genuises can flourish and benefit all rather than bureaucratic methods which are like dictature and tends to shrink to fit with the disastrous consequences. Who wants it?

    14. Pingback: Public Option Redux Redux? – Blog Watch

    15. mrsmaria says:

      The Federalism should be kept to the availability of information and records, but never used to prescribe actual care standards. Health care standards are acceptable but must never be given the status of mandatory.

      You can read more: http://passkidneystone.com

    16. Bobbie Jay says:

      Any study influenced by government will result in more government.

    17. Drew Page, IL says:

      To Louis Levy in Houston — You want to run that by us again? I'm not quite sure of what you are saying.

    18. Jack Rough Columbus, says:

      The States are sovreign and could have rejected welfare, food stamps, medicare, medicade, no child left behind, and numerious other federal mandates. Why do we have to aquiesce to small government accepting big government.

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