Governor Palin vs. the Boys on Government Mandates and Health Care Reform

As Ian highlighted earlier, Governor Palin levied some criticism at Governor Mitt Romney’s health care mandate today at stop in Massachusetts on her "One Nation" bus tour. Governor Palin commented on  Romney’s plan and how that plan will be received by Tea Party voters:

"That perhaps will be a big challenge for him because tea party activists are pretty strident, in a good way, in making sure that the candidate that many of the tea party patriots will support — the candidate has a record of living out the principles that tea party patriots do embrace," she said.

Palin added that Romney may have a "good argument" that what he implemented in Massachusetts applied only on a statewide level and would not be appropriate nationally. But then she quickly went back on the attack.

"However, even on a state level and a local level, mandates coming from a governing body, it’s tough for a lot of us to accept because we have great faith in the private sector and in our own families and in our businessmen and -women in making decisions for ourselves," Palin said. "Not any level of government telling us what to do."

Governor Romney’s health care plan is considered by many to be his potential albatross in the 2012 race. He passed the health care plan by first promoting the personal mandate using language often supported by conservatives–personal responsibility. Now, he is trying to defend his legislation by attempting to claim that such a plan was supported by another ideal conservatives tend to support–federalism. Governor Romney’s rhetoric, however, is not supported by his policies.

Romney is not the only candidate in the race who has supported a health care mandate. Although Governor Tim Pawlenty did not support a mandate nearly as vehemently as Romney, nor did he pass any mandate legislation, he  is on record saying he thought a health care mandate was "potentially helpful" and that he was "open to" a universal health care law. Speaker Newt Gingrich flip flopped on his support of government mandates one day saying that all have a "responsibility to pay" , only to walk back his comments the next day.

Governor Palin, on the other hand, has been the most vocal critic of government involvement in health care over the past two years ranging from criticizing potential of government bureaucrats to ration health care to emphasizing the need for tort reform. Her rejection of government overinvolvement in health care and her support of patient centered and market based solutions are not simply lip service; they are the types of policies that she supported as Governor of Alaska as well.

One of the first things Governor Palin did upon taking office was to appoint a health care council (the Health Care Strategies Planning Council–HCSPC) to assess how to address the health care challenges faced by Alaskans. This health care council generated a report chock full of market centered ideas and focused on the choice of the individual, as the American Spectator reported shortly she was selected as Senator McCain’s running mate:

The recommendations of the HCSPC were decidedly pro-market and emphasized the power of the health care consumer: "With respect to lowering costs, insurance that is portable and consumer-owned plays a central role… consumerism is an essential component of bringing rationality to the health insurance structure in Alaska." Such a consumer-driven approach assumes, of course, that the patient possesses useful data about hospitals and physicians. Thus, the HCSPC also advocated providing patients with "cost and quality information about health care providers and services."

Additionally, this council recommended health care solutions that were based on true personal responsibility–a responsibility for one’s personal health, not a responsibility to a government mandate:

First, Alaskans must be encouraged to play a much greater role in their own wellness by having both a personal and financial “stake” in their own health. Having a “stake” in their own health is the product of a personal investment in wellness, and realizing the financial benefits of saved dollars by maintaining healthy lifestyles. In the opinion of the Council, the most effective mechanism for increasing the personal health investment of Alaskans is incentivizing and supporting positive change.

Additionally, the Council recommended that decreasing the number of uninsured Alaskans be addressed by not by implementing a mandate, but by increasing choices:

Consumerism is an essential component of bringing rationality to the health insurance structure in Alaska, and extending coverage to as many Alaskans as possible. The key to success is insurance that at least covers catastrophic care, so no Alaskan suffers from the extreme financial burden of catastrophic or unanticipated health events. In addition, insurance must be consumer-owned, market-responsive and portable; this recommendation has received attention elsewhere in this report. Coverage options debated in the Council’s discussions, which are by no means exhaustive, include Health Savings Accounts, Health Opportunity Accounts, and high-deductible plans with a strong prevention component. This list provides a solid foundation from which to continue the ongoing discussion about expanding health care coverage for all Alaskans.

From these recommendations, Governor Palin proposed the Alaska Health Care Transparency Act, which the aforementioned American Spectator article does a good job of summarizing:

Having received HCSPC’s report in December of 2007, Governor Palin subsequently introduced the Alaska Health Care Transparency Act to the state legislature. The bill not only called for the kind of price transparency recommended by her planning council, it also included a provision advocated by many free market health care reformers — repeal of the state’s Certificate of Need (CON) statute. This provision was designed to introduce much needed competition into Alaska’s health care market, and it created trepidation in the state’s health care establishment. As the Juneau Empire phrased it, "Gov. Sarah Palin frightened Alaska hospitals when she proposed repealing Certificate of Need regulations that many say help them stay in business."

STATE CON LAWS originated, like so many bad health care ideas, with a mandate from the federal government. In 1974, states were effectively told by Washington that no new medical facilities could be built unless a "public need" had been demonstrated. The idea was to reduce costs, but the only measurable effect of this federal decree was a morass of bureaucratic red tape that stifled competition in the health care market. In 1987, the federal statute was finally repealed, but many states inexplicably kept their CON processes in place. Alaska was one of them and, as Governor Palin put it in an editorial for the Anchorage Daily News, "Under our present Certificate of Need process, costs and needs don’t drive health-care choices — bureaucracy does. Our system is broken and expensive."

Governor Palin highlighted this market centered approach based upon true personal responsibility, not government mandate, in both her 2008 and 2009 State of the State addresses. In 2008, Governor Palin said (emphasis mine):

Alaskans want health care in the hands of doctors, not lobbyists and lawyers. We are considering what other fiscally conservative states have done to incentivize employers to provide medical insurance for employees, based on the free market. But comprehensive reform must include not only government reform, but Alaskans choosing to take more personal responsibility. All Alaskans must do better to be better, and healthier.

In 2009, Governor Palin re-iterated this approach to health care and government’s proper role in helping those who need it and in encouraging better personal choices (emphasis mine):

In this chamber, we share a commitment to serious health-care reform. We’ve learned from experience that all the answers do not come from Washington. When Congress turns to health-care reform this year, we look to our delegation to make the case for greater competition, more private sector choices, and less litigation in the health-care market. But we’re not going to wait. Here, reform can move forward without delay.

I look forward to working with you on adjustments to kid’s health insurance. We’ll fund more early screening – for example, for autism – because early detection makes all the difference. We’ll focus on preventing disease and promoting healthy living. I’ll ask that physical education be incorporated into daily school schedules, too. We have alarming levels of heart disease, diabetes, childhood obesity – and all of these maladies are on the rise. Now, I won’t stand here and lecture – for very long – but health care reform on an individual basis is often just this simple: we could save a lot of money, and a lot of grief, by making smarter choices.

It starts by ending destructive habits, and beginning healthy habits in eating and exercise. In my case, it’s hard to slack when you have the ever-present example of an Iron Dogger nearby. But many of us could use a little more time in our great outdoors – and when you live in the Great Land, there’s no excuse.

Protecting good health is largely a matter of personal responsibility, but government policy can help. Our new Alaska Health Care Commission will recommend changes that affect the well-being of Alaskans far into the future.

Governor Palin’s health care transparency bill ultimately did not pass through the legislature, but her consistency through her tenure as Governor up until now as a potential presidential candidate show that she is committed to true personal responsibility, a proper and limited role for government in health care, and market drive, patient based solutions. Juxtapose these firm and consistent conservative policy stances to the liberal policies or flip flopping on the part of the Boys, and it is clear that Governor Palin is right yet again on the issues.



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