Despite (or perhaps because of) federal healthcare reform passed out of Congress a decade ago, healthcare issues are at the forefront of the public debate going into the 2020 election cycle.
Over the holidays, I had the chance to attend the annual State Health Policy Summit hosted by the Cato Institute, a libertarian-leaning national policy think tank. The summit presented thought-provoking policy solutions to some of today’s most pressing healthcare issues.
For policymakers and the public interested in healthcare reform, the following insights provide some context for how reform can be achieved in the coming months and years.
Insight 1: The difficulty of reform efforts will require strong principles
Some policymakers today want to wipe the slate clean on our current system by moving to a government single-payer healthcare model. Under Medicare for All, the government would be the sole purchaser of healthcare. The magnitude of its buying power would allow it to set prices and ration care, destroying any semblance of a market that may remain in healthcare today.
Other policymakers at the state and federal level are hopeful about the possibility of reform in the current system. The complexity of healthcare’s current financial and regulatory environment means that reform is inherently challenging. This insight, while obvious, reminds us of the need to keep strong principles at the forefront of policy decisions.
In healthcare, as in other policy areas, the principle of freedom is arguably one of the most important. Healthcare providers should be free to meet the needs of their patients without government restrictions, such as Certificate of Need. They should be free to practice within the full range of their training, through the expansion of scope of practice regulations. Patients should be free to make healthcare decisions with full knowledge about prices and quality from their providers. If freedom becomes the central principle in healthcare reform, many of the problems of the current system can be overcome.
Insight 2: Promoting free markets will often conflict with the current industry
Conservatives have long struggled with the distinction between being pro-business and being pro-free market. The former leads to cronyism and protection of the reigning business interests. This is the realization of politics’ worst caricature: elected officials putting the big money interests ahead of the interests of the people they represent. This type of corruption can sneak up on even the most originally well-intentioned of policymakers if they are not on guard against it.
But the reality is that reform can be legitimately harmful to the current actors within the healthcare space. They will be forced to realign their business models in order to operate successfully within the new regulatory environment. Providers or insurers artificially protected or subsidized by the government under the current regulations may very well go out of business. But the beauty of the market is that – without government barriers – the healthcare industry can adequately respond to the demand for healthcare. Through increased competition, problems such as administrative bloat, outdated service models, and overinflated prices would be replaced by healthcare businesses that better meet patient needs.
Insight 3: While federal reform is desperately needed, states can make meaningful changes within the current system.
Looking at the quagmire of the current healthcare landscape, it could be easy for state lawmakers to wash their hands of the responsibility of large-scale reforms. But in reality, there are a variety of policy changes that North Carolina lawmakers could make today in order to open up the healthcare market of the state within the parameters of the current federal system.
Civitas has long touted the benefits of repeal of the state’s burdensome Certificate of Need laws. Other possible reforms include the repeal of unnecessary insurance mandates and allowing for direct primary care arrangements, to name a few.
The work of healthcare reform will be challenging, requiring principled leaders who are willing to stand against entrenched industry interests in order to protect the freedom of everyday North Carolinians. But going into the new decade, change is desperately needed at both the state and federal level.