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MN2020 Journal: Greedhead Health Care Reform

September 18, 2009 By John R. Van Hecke, Executive Director & Fellow
It's time to speak an unspoken health care reform debate truth: conservative public policy advocates are only interested in policy changes with a clear, narrow self-benefit. They prefer a health care policy that contracts health insurance coverage rather than expands it. Publicly-funded or publicly-directed benefits would only accrue to conservative public policy supporters.

Let's call this the greedhead option.

Conservative health care reform opposition is dressed in sober insistence on fiscal responsibility. I don't believe that for a second. The modern conservative movement throws fiscal restraint under the bus faster than hogs rush for slop. Given the opportunity, elected conservative officials spend what they have, then borrow another pile of money and spend that, all while insisting that government is out of control.

Challenging conservative obstinacy only earns insistent shouts of socialism and barely-veiled anti-American accusations. Consequently, health care reform, from the conservative perspective, isn't really about health care reform at all. Rather, it's a power fight over public resources and benefits accrual.

Unless those resources and benefits narrowly flow to conservative interest groups and conservative public policy supporters, conservative elected officials decry the health care reform effort rather than ask the more traditional and honest political/policy question, "what's in it for me?"

If you are confused, you are not alone.

Minnesotans are, I believe, perplexed by the nation's health care reform debate. We clearly possess strong opinions and concerns but we don't entirely understand this determined national conservative anger. That's unsurprising because, as Minnesotans, we're just not good at sustained outrage. We know what works, what doesn't, and what to change.

As a high service, high quality, high cost, non-profit HMO state, Minnesota health care works pretty well. Turns out, that's not the case in most of the nation.

Minnesota routinely posts one of the highest health insured state population rates in the country. The most recent data rank Minnesota third. Three of every five Minnesotans' health care coverage is tied to an employer. Whatever challenges we face, we're not as bad off as Arkansas or South Dakota. The question we face is quite simple: how do we improve on a decent situation?

Federal economic recovery stimulus spending is subsidizing state health care investments by $2 billion a year. Without that, state budget balancing spending cuts would've gutted a great many programs although elected leaders like to pretend otherwise. Given that Minnesota's health care costs have slightly outpaced the national average since 1991, it's important to understand that federal investments are an increasingly critical element of Minnesota's health care future. In time, Minnesota will not be able to afford to go it alone.

Earlier this week, Governor Pawlenty advanced a more sophisticated version of the greedhead option. He suggested that Minnesota would exercise its 10th US Constitution Amendment rights and opt-out of federal health care reforms. He quickly retreated from this position in light of widespread criticism and public derision.

Citing the 10th Amendment is conservative code-talk for a states' rights legal framework asserting state over federal primacy. States rights references were last commonly used resisting the civil rights movements, preserving race based government service delivery, and sustaining racial exclusion policies.

The 10th Amendment reads, "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." It is, in effect, the powerless amendment precisely because it's a vague catch-all and doesn't specifically address anything. Conservative legal scholars have suggested that this nothingness actually constitutes substance, if only in their minds.

Let's stop kidding ourselves about conservative public health care policy reforms. Minimally, conservative public policy leaders want to maintain the status quo, increasingly driving affordable health care coverage beyond average people's means. This is a poor prescription for growth. The greedhead option is no option at all.

Minnesotans have learned and applied several lifetimes' worth of health care lessons. We've invested in affordable health care and our state has benefitted many times over. Let's keep that perspective in mind even as conservatives offer division and distraction. Moving Minnesota forward requires affordable, progressive health care solutions.

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