Vox.com just inadvertently explained why conservatives should support the Graham-Cassidy Senate bill that would replace Obamacare.
Writing at the liberal news outlet on Tuesday, Sarah Kliff describes Graham-Cassidy as the “the most radical” of all the GOP health bills introduced this year. Kliff laments that Graham-Cassidy would repeal the individual mandate, would remove the requirement for private insurers to offer plans to those with pre-existing conditions, and would replace the current Medicaid payment system with block grants to states.
From my perspective, each of these factors are good reasons to support the bill!
Yet, Graham-Cassidy’s greatest strength is its tenet Kliff opposes most: Medicaid block grants. Were the bill to become law, states would receive grants of a set value allocated on the basis of population. They would then be able to use that money as they see fit. This reform would break the current mold of Medicaid in which the federal government basically covers all expenditures, regardless of relative efficiency, waste, or costs.
The problem with Medicaid’s current system is that, “Absent incentives for cost reducing reforms … too many healthy, working age individuals are using [Medicaid] instead of paying for their own care. This spending free-for-all is fueling our catastrophic national deficit and destroying the imperative of personal responsibility.”
Unless we want socialized medicine, we must embrace major reform.
Still, Kliff isn’t done, she makes another conservative argument in complaining that Graham-Cassidy means “States would be able to use this new lump sum for all sorts of things.” This is bad because Graham-Cassidy “means it’s essentially up to states to decide, in two years, what sort of health care system they want to run. There is no template to follow.”
Kliff references Edwin Park from the Center on Budget and Policy Priorities, a liberal think tank, who worries that “A state could say, I’m going to take all this money to pay doctors for uncompensated care and not provide any health coverage, you can spend the money on a whole host of other services that have nothing to do with expanding insurance coverage.”
Well, yes, a state could do that.
But assuming our state legislatures and governors continue to be elected, they’ll have a pretty significant political incentive to provide services that are sustainable and that their voters want! This cuts to the heart of the liberal-conservative disagreement over Graham-Cassidy. Where liberals believe that the federal government should dominate health service control across the nation, conservatives believe state control would promote greater accountability and effectiveness.
According to the Kaiser Foundation’s Larry Levitt, who Kliff interviewed for her piece, state control is bad because “we have no idea what states would do.”
Again, that speaks to the operative question here: Do we trust local power? Maybe we should. Is it inherently less trustworthy than federal power? (Incidentally, a cursory look at Federal Election Commission records proves that Levitt is an avowed big-government Democrat.)
Ultimately, however, Graham-Cassidy’s greatest strength is its moral honesty. Kliff complains that it “punishes the states that have expanded coverage the most, either by expanding Medicaid or getting a lot of people signed up for the marketplace (and thus have higher marketplace subsidies flowing into their state).”
In doing so, Kliff pretends that federal funds are free money. She’s wrong. Every dollar we throw at broken entitlement systems is another dollar added to the federal deficit: money that future generations must pay off.
Republicans don’t have all the answers, but improved health care cost-sensitivity and delivery are crucial for our better future. Graham-Cassidy is right to relocate power to state capitals.
