Be it resolved ...
What a year 2011 was. After 12 months of fractious confrontation and policy gridlock, for the arena of health policy in particular, maybe it's time for politicians in Washington to take a hard look in the mirror and commit to growing up a little in 2012.
So here are three resolutions they ought to make, and keep, to make for a healthier, wealthier and wiser America:
1. Stop trying to run everything.
From light bulbs to guitars to prescription drugs, Washington continues to crack down on the ability of the American people to do what they want and buy what they want. Regardless of the outcome of the case pending before the Supreme Court on President Barack Obama's individual mandate, it's clear the federal government now exercises incredible control over the already weakened health-care marketplace, to the point that it might not be a marketplace for much longer.
Under a Washington-knows-best approach, the opportunity to create thriving models of coverage at the state level has been essentially reduced to the pool of state employees. Flexibility relies on the whims of whatever administration happens to be in power in Washington, not on state officials who tend to know and understand better the unique needs of their populations.
We see this particularly within the ghetto of Medicaid, already the largest line item for most states, which requires the blessing of the federal government for nearly every significant alteration to better meet the needs of the most sick and most poor.
And even if plans are popular and successful, such as Indiana's approach, the math matters less than the politics.
2. Realize that social engineering doesn't work.
The American people already have. The unpopularity of ObamaCare is astounding. The most recent polls on the subject have the law at below 30 percent approval -- essentially indicating only the president's most loyal supporters now believe it was the right way to fix things. It's difficult enough to get half of Americans to agree about anything -- but getting nearly 70 percent of Americans to oppose the individual mandate is about as clear-cut as it gets.
At a recent event in Washington, a Capitol Hill staffer posed a question to a panel of experts about why the individual mandate is so unpopular. He couldn't understand why an idea that makes so much sense to him is viewed with such disgust outside the Beltway.
The reason is clear: Americans still fundamentally reject government encroachment in areas they view as off limits, especially when the primary rationale is an image of what the policymakers think society ought to look like, as opposed to what it is.
No matter what happens in the upcoming Supreme Court ruling, expect Congress to re-open Obama's law for major changes after the 2012 election. There is just too much opposition for the law to survive as it stands.
3. Stop pretending our course is sustainable.
This resolution builds on the lessons from Europe this year, where we found out wealth redistribution on massive levels is sustainable, all the way until it isn't.
Consider the circumstances in Maine, where Gov. Paul LePage recently pointed out that his state has 453,000 welfare recipients, while 445,000 paid taxes. Medicaid now accounts for 21 percent of Maine's spending, up from 12.4 percent in 1998.
And Maine is not an outlier -- it is the rule.
As unemployment remains high and ObamaCare's massive expansion of the Medicaid system approaches, it is now apparent that millions of Americans will soon be shifted onto a taxpayer-funded, government-run American health system with outcomes that range from the barely acceptable to the plainly awful.
This system is not sustainable. But the political will to change it seems absent from leadership in Washington. It will take governors coming together to demand a shift to force Washington to stop treating Medicaid reform like the ugly stepsister and embrace one of the few areas where Democrat and Republican governors alike agree that more flexibility and freedom is mandatory.
By making these three resolutions, politicians will recognize that America cannot adopt a permanent entitlement structure for a new plateau of unemployed and underemployed citizens. And they will recognize that where freedom exists in the health care space, people are thriving. Governors with a mind toward innovation are rejecting top-down statism and mandates, taking small but important steps toward empowering consumers.
Just as welfare reform required state success to export to the national level, these small steps might, if protected from federal encroachment and social engineering, reverse our unsustainable course. It will take leadership rising from the citizenry and the states, leadership more principled and reliable than the power brokers of the day.
And if they commit to this task, America can ultimately attain the health care and entitlement system it deserves -- where permanent redistribution is banished, personal responsibility is renewed, and competition, transparency and innovation thrive.
So go ahead, Washington; look in the mirror. You can do it. And if you can't, well -- we promise we'll help you out.
Benjamin Domenech is a research fellow at The Heartland Institute and managing editor of Health Care News .