On Healthcare Reform

There is a lot that’s good with healthcare in the United States. People from all over the world travel here because we have the best hospitals, the best doctors. Medicine in the United States provides the best care in the world. Still there are issues with our healthcare system that are of concern and must be addressed. Insurance costs have gone up dramatically in the last few years and there are still some people who are under-insured.

In theory, people should be thrilled with the prospect of improving healthcare. So why is there so much apprehension with the healthcare proposals coming out of Washington? The short answer is that the reform being proposed is dealing with a lot more than we bargained for. Another side of this coin is that the objectives for reform are very slippery moving targets. All we hear from Washington are a bunch of solutions, but solutions to what. It seems very much like instead of solving problems, we are creating new ones.

I’d like to offer an approach to achieving meaningful, acceptable healthcare reform that I believe will be welcomed by our people. This is totally different from anything that was ever done in the political arena (as far as I know). The process that I envision proceeds in several steps. Indeed, the process is somewhat convoluted, but there is so much at stake.

Step 1: Compose The
Declaration of Healthcare Reform The House of Representatives will put together a 30-50 page document listing the objectives, and only objectives, not implementation methodology, of healthcare reform. This is essentially a set of bullet points, written in layman’s English, as to what healthcare reform will accomplish. The resulting declaration of healthcare reform objectives may contain any objective that the House sees fit to include, such as, 100% healthcare coverage for illegal aliens. However, any objective that is not included in the final declaration will not find implementation in the final healthcare reform package.

Step 1a: Presidential Thumbs up We don’t want to leave the President out of the loop in this important part of the process. Why? Because by all accounts the President should have a broader view of our citizens' needs. Indeed, the Presidential Thumbs up is a different approach for obtaining Presidential approval. My intent is to supply the President with a vehicle for input into the declaration process. So, if the President approves of the Declaration, he or she will call a public press conference and publicly give the Presidential “Thumbs-up”, signaling that the process proceeds to Step 2. On the other hand, if the he or she does not approve of the Declaration, the President will register disapproval at the press conference with a Presidential “Thumbs-down” and the declaration goes back to the House for revision.

This is healthcare reform for our citizens and by our citizens. So it is absolutely essential that the President has an informal role in this process. That is why I chose this informal concurrence modality. If we would become more formal at this point of the process, it would bring us back to the “business as usual” thinking. That is the last thing we need, if we are to make progress with healthcare reform in a reasonable amount of time. I am also certain that no President would feel slighted if there is a real opportunity for movement with healthcare reform.

Step 2: Ratify The Declaration of Healthcare Reform Voters across the nation will have the opportunity to examine the objectives in the Declaration and approve or disapprove each bullet point. The voters’ ratification will proceed on a per bullet point basis, requiring 2/3 vote for each objective to be included in the final implementation. Those objectives that obtain a 2/3 vote will be implemented, the others will not. The ratification process will follow a strictly popular vote principle.

Step 3: Trial Implementation of Healthcare Reform Congress now has in hand the Declaration of Healthcare Reform as ratified by the people. Both houses will compose provisional legislation which implements the objectives of the ratified declaration. The legislation will be formulated as a set of bullet points detailing how the declaration’s objectives are met. All the bullet points relating to a single objective will then be formulated as a single referendum item to be considered by voters as ballot proposals hopefully in time for the 2010 election cycle. There will be a separate ballot proposal for each objective.

Step 4: Voter Referendum Although this is not the way it is done in Washington, people, voters, must be entitled to choose how their healthcare will work. This is the reason for the objectives and referenda. By the way, who says that healthcare should be administered by the Federal government? Perhaps this should be done by the state? Or, perhaps, local government will simply police the quality of healthcare? All this will be determined between the voter ratified Declaration and the referenda.

This is certainly very unlike the usual approach to legislation. So, why am I suggesting such a drastically different road to providing healthcare reform? People do want reform, but they are wary of what politicians have been cooking up. HillaryCare failed to win the day and it seems like current attempts won’t fare better. It’s about time that we put our citizens in the driver seat in choosing our own destiny.

A little bit of explanation on how the Declaration of Healthcare Reform is composed would be helpful. On the one hand, the Congressional agenda for healthcare can be displayed in its full glory. Congress can add the objective of rationing. It can also add the objective of capping medical malpractice awards. It can add the objective of funding all healthcare via a single payer, or an objective against a single payer system. Obviously both objectives can’t make it to the final Declaration. The objectives should be clear and quantitative wherever possible. For example, the objective of capping medical malpractice awards can include a general schedule of awards for various categories. Again, only objectives are included, no implementation. Implementation is dealt with in the last stage.

The Senate is not included in the Declaration stage at all. With 435 strong, the House alone will provide sufficient input into formulating the Declaration. It is also an added benefit to put the members of the House under a magnifying glass. Since objectives are much more transparent than implementations, voters will get to see how their Congressmen stand on the issues. This should give the members greater incentive in dealing fairly with the objectives in the Declaration.

The final question then is of Constitutionality. In this regard we can’t falter. The Constitution has been so badly battered lately, that we can’t afford it taking more flak. If this whole approach is unconstitutional, then it must be dropped forthwith, and we have to find another way.