New Year, Same Fight

(Editor’s note: This item originally appeared as an e-mail alert from the John Locke Foundation on Jan. 3, 2011.)

Incoming Florida Gov. Rick Scott and Yale Professor Jacob Hacker offer two visions of the future of American health care. Scott is focused on the immediate problem that Medicaid is killing state budgets, and says block grants with more individual control of their dollars is the best way to go. The alternative is a program that is unsustainable even before ObamaCare (witness Texas), and ripe for Constitutional review.

Stephen Moore's interview with Gov. Scott is worth reading:

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Mr. Scott believes that the growing financial squeeze from programs such as Medicaid means that "there's going to be a lot of pressure from the new governors to get Congress to block-grant the [Medicaid] money back to us." The theory is that the states can more efficiently administer the program.

His cost-containment strategy involves creating a health-care voucher for eligible Medicaid recipients so that they can shop around for health care and explore money-saving options like high-deductible health savings accounts. "If poor people are spending their own money, it is amazing how fast they will figure out how to keep a lid on medical bills," he says, based on his own experience in the private sector.

Critics say this will inhibit preventive care, but Mr. Scott scoffs at the claim. "If the money is yours, don't you think you will change to a healthier lifestyle?"

Compare that with what Jacob Hacker, intellectual godfather of ObamaCare and the public option, wrote in the latest edition of the journal Democracy. Hacker admits the law "looks like a Rube Goldberg contraption ... charitably described as complex." It rests on further expanding Medicaid, creating exchanges and transforming "the present voluntary, regulated, subsidized system of workplace insurance into a less voluntary, more regulated, and less subsidized system." He criticizes the consolidation among insurers and providers, but overlooks ObamaCare's role in driving insurers out of markets and driving doctors into hospital physician networks. Hacker's goal is still to create a public-option that would become a single-payer. His vision requires public acceptance of the law

Public acceptance of ObamaCare should be difficult to attain. The individual mandate is even less popular while the federal Department of Health and Human Services has approved price controls and has "revived death panels."

The future of health care remains is increasingly in the hands of patients who use the internet to self-diagnose and create their own medical histories despite the best efforts of the FDA to keep promising new therapies out of their hands.