Why universal health care can not work at a federal level, but can work at a state level - Essay Example

? Why universal health care cannot work at a Federal level, but can work at a level. Federalism leads to increasingly decentralized and inherently local government, which can efficiently manage healthcare cooperatively out of natural care and compassion, as opposed to the national implementation that is doomed to failure due to the size of the bureaucracy and apathy of official policy. Dr. Harold Pease has illustrated this issue with his discussion of California’s energy policy in the 1990’s, which led to frequent breakdowns and “brownouts” rather than the propounded goal of the central planning committee. (Pease, 2010) He wrote, “States have the tendency to look at sister states for models and to borrow from them in refining their own programs. These places of experimentation work to everyone’s advantage. What if we had federalized California’s failed energy policy?” (Pease, 2010) From this criticism, Pease and others claim that it is preferable to enact political experiments with universal healthcare on the State level, so that competing systems can be tested, refined, and adjusted to provide the most efficient and cost-effective public policies, rather than committing to one, single Federal system that remains untested and has a greater chance of failing for everyone. The system of Federalism and decentralized healthcare would thus provide more competition, room for experimentation, and flexibility of operations than would a single national health program. Along with this criticism is the belief that small and local organizations can provide a better quality of healthcare than large, difficult to manage, and over-sized organizations which may be tasked with too many official responsibilities to provide a personalized level of service. While it is easy to extol the virtues of decentralized and local forms of government, other national governments in Europe and around the world have also enacted “universal” healthcare programs at the Federal level and managed them successfully within the limits of their mandate. The United Kingdom, for example, has a national healthcare system based on socialist principles, as does France, Sweden, and other smaller countries such as Cuba. In this regard, it is possible to conclude that the residual anti-communist sentiment from the Cold War has conditioned Americans to fear socialized medicine despite the fact that it is engrained as a fundamental human right in international treaties. The other side of this view is that it is not a cultural aversion to socialism but rather a national preference for capitalism in America that makes the people to choose private healthcare solutions over government programs. However, the problem is generally not that the rich cannot afford healthcare, but rather that the poor are denied access to it due to lack of financial resources, and society must make a choice as to whether to try to provide a social “safety net” for all people that relates to the view of healthcare as a human right or to allow those who are poor, marginalized, or uneducated to suffer needlessly because they cannot afford healthcare services. In a country as wealthy and affluent as the U.S., with the world’s leading economy, it seems morally wrong to pretend that society does not have enough money to take care of the poorest people, especially when so much is wasted on other programs, issues, and activities collectively. Thus, universal healthcare requires a mandate from the people to government in order to make it successful, and this can be communicated in elections, demonstrations, polls, or publications. It is in the electoral results that federalism can be particularly helpful in allowing communities to express their differences of opinion and to build policies that uniquely solve their own needs with public resources. For example, Massachusetts was successful in enacting a near universal healthcare policy in their State years before the Obama reforms, as was Illinois. (Volpe, 2008) California, on the other hand, tried and failed to pass a universal healthcare bill on the State level, due to a breakdown of negotiations over budgetary issues. (Volpe, 2008) This suggests that decentralization and federalism are not a guaranteed panacea for all of society’s ills, but rather still contingent on the political process and the public representatives’ own ability to compromise in negotiating a policy solution. While it would seem that it is easier to build coalitions on the local level in comparison to the national level due to the size of the constituency, a State such as California is larger economically than most foreign countries and its population displays a similar diversity of interests. The problem is thus repeated with federalism on the State level if the local government is unable to come to a policy agreement in providing services in a universal, egalitarian, and practical manner. The Robert Wood Johnson Foundation has studied the issue of federalism as part of their State Initiatives Program and concluded that rather than focusing on exclusively national healthcare programs or totally decentralizing authority for public healthcare services to the States, a combine policy approach is most beneficial. In their report, entitled “State and National Health Care Reform: A Case for Federalism” (2010), they write: “Within our structure of federalism and given the complexity of the health care system, it is imperative to build upon the respective strengths of both state and federal governance to fashion health reform solutions with the greatest potential for success.” (RWJF, 2010) This combined approach makes sense, because while States may be able to act more quickly, specifically, and in accordance with local community needs than the Federal government, in instances where the individual States fail to act, there needs also to be assistance at the national level. Medicare and Medicaid provided this public assistance in healthcare as a national program since the “Great Society” reforms of President Lyndon B. Johnson were enacted in the 1960s. Johnson’s programs were born in the era of the civil rights struggle, when there was more concern among national politicians for the plight of the poor due to the teachings of Dr. Martin Luther King, Jr. The effect of moral reasoning and humanitarian concern cannot be underestimated as the driving force for compassionate legislation such as that relating to universal healthcare. In the opposite approach, the selfishness and corruption that is seen as part of the corporate influence in representative government can be one of the main obstacles to overcome in organizing public healthcare responses to meet the needs of the poor in society that cannot afford healthcare services on their own. In summary, the actual costs of healthcare in America are related to the combination of profit-seeking companies in the medical establishment, the proliferation of insurance programs that the majority of Americans use to cover treatment costs, and the lack of a socialized medicine on a national scale. Federalism appears to be the preferred means to address social inequality in the healthcare system due to the Constitutional issues related to the 10th Amendment which states, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” (Volpe, 2011) However, as the example of the State of California shows, there is no inherent guarantee that federalism will work better than national legislation, and in fact, gridlock, obstructionism, and political corruption can exist at the local and State levels just as it does in the U.S. Congress. If the States are unwilling or unable to act politically on issues of universal healthcare, then the national government will be required to attempt to solve the problem. Nevertheless, in both instances, the vital issue is in securing the electoral mandate for socialized medicine, which is anathema to the political sentiments of many Americans who abhor a “tax and spend” policy filled with governmental inefficiency and waste, or who equally reject income redistribution programs that seek to address the issues of inequality between rich and poor. Because of this engrained sentiment in the American electorate, the determining factor in making an egalitarian social policy that enacts universal healthcare is not found in forcing the issue upon the people through legislation, but rather for the people to vote for progressive policies, candidates, and parties that seek a more compassionate and socially just society. Until people become bound by a genuine understanding of the need for society to take care of all people, rich and poor, equally and to provide healthcare services, like education, as a basic and fundamental human right, both federal and State level programs will be bound to fail due to inherent human selfishness, greed, and close-mindedness. Therefore, in conclusion, the collective moral sentiment as expressed through electoral politics can be seen as more determinant and significant in leading to universal healthcare policies in society than any other factor. Sources Cited Holahan, John; Weil, Alan; and Wiener, Joshua M.. Federalism and Health Policy. Urban Institute Press, 2003. Web. 10 Oct. 2011. ‹http://www.urban.org/pubs/federalism/›. Pease, Harold. Health Care vs. Federalism. California Tenth Amendment Center, 2011. Web. 10 Oct. 2011. ‹http://california.tenthamendmentcenter.com/2010/04/health-care-vs-federalism/ ›. RWJF. State and National Health Care Reform: A Case for Federalism. The Robert Wood Johnson Foundation, State Coverage Initiatives, 2010. Web. 10 Oct. 2011. ‹http://www.statecoverage.org/node/1323›. Volpe, Mike. Federalism and Universal Health Care. THE PROVOCATEUR, September 10, 2008. Web. 10 Oct. 2011. ‹ http://theeprovocateur.blogspot.com/2008/09/federalism-and-universal-health-care.html›. Read More