Taking and Giving Away Power in a Federalist System

This week's podcast A City Throws in the Towel and documentary Cheney's Law tell us two different tales about power in a federalist system with a separation of powers. On one hand, we have a story about the Bush Administration successfully attempting to consolidate power in the national executive branch. In the other we have the city of Reading, Pennsylvania ceding its power to the state in order to avoid financial ruin. In both of these instances we can see how a policy decision like re-defining torture and selling off government property can have a larger meaning in terms of the distribution of power between branches and levels of government. We can also think beyond the effects on the executive branch (in Cheney's Law) and the city government of Reading (in A City Throws in the Towel) and hypothesize about the long-term consequences of these decisions for other branches and levels of government. Giving up power is a very difficult thing to do, and once power is consolidated or distributed it tends to stay that way until another emergency or shock to the system emerges.

In terms of the executive branch, it remains relatively powerful since Bush and Cheney have left office. The Obama administration continues the practice of issuing signing statements to laws, but I think the debt ceiling negotiations revealed that Obama is more hesitant about exercising executive power. Here's a NYTimes article about executive power under Obama.

In A City Throws in the Towel we heard about Reading, PA as an example of a city that was taken over by the state as a financial disaster area. The podcast hints at the fact that many cities throughout the nation are facing the same issues, as population decreases and poor economic conditions decimate their tax bases. In Reading's case they chose a state takeover, but this is not always the case. The city of Detroit, Michigan is currently at risk of being involuntarily taken over by the state if they cannot cut $200 million in spending.  Local governments are not protected by the Constitution, unlike state governments, so this may be a coming threat for many cities and counties. State governments are feeling similar financial crunches, particularly because so many have balanced budget provisions in their constitutions or state laws. The question remains, what will happen to our federal system if states can no longer meet their financial obligations to residents?

My Thoughts on Healthcare Policy

I hope by now you have all seen one of the assigned documentaries for this week, "Sick Around America" or "Sick Around the World". The first discusses many of the problems individuals face in the US healthcare system and the second discusses the ways, in which, different countries have structured their healthcare systems. Both of these documentaries were made prior to the passage of the healthcare reform bill. I posted a good overview of the new bill on the blackboard site.

I chose healthcare policy as our first substantive area because I hope you all have some familiarity with the political debate over the healthcare reform bill that was passed last year. Healthcare policy is also one of the issue areas where I have some expertise. For those of you who watched "Sick Around America", Karen Pollitz was one of my professors in my MPP program at Georgetown.

I think the first important point that Peters brings up is that government intervention in healthcare is not new in the United States. The U.S. government has provided healthcare services to certain populations through Medicare, Medicaid, and the VA for much of the 20th century. The U.S. government also invests substantially in research and development and regulates the pharmaceutical, insurance, and healthcare markets. At the same time, the United States has historically done very little to address access and cost issues compared to other developed nations.

As Peters points out, we are usually addressing three issues when we discuss healthcare policy: access, cost, and quality. Sometimes these issues can be in conflict. Increasing access to healthcare for the sick and elderly risks sacrificing cost containment. A market system may provide incentives to increase quality for those who can afford to pay for cutting edge services and pharmaceuticals, but it limits access to the highest quality care to only those who can afford to pay. The United States does better on quality, at least for those who can afford the best services, and does poorly on access and cost containment. Of course, the lack of access shows how some aspects of quality, access, and costs are related. At the population level, our healthcare system does not perform well in terms of healthcare quality measures because so many individuals are priced out of the healthcare system.

The healthcare reform bill passed by Obama in March, 2010 is mainly concerned with reducing costs and increasing access to healthcare. While it will fall short of universal coverage, CQ Researcher estimates that it will cover 32 million of the 45 million uninsured individuals in America. The bill also provides funding for pilot studies to determine how best to restructure our healthcare system to incentivize preventive care and efficient and effective medical treatment. The current controversy over the bill concerns the constitutionality of the individual mandate, which requires everyone who can afford it to purchase health insurance or face a monetary fine. The issue will almost certainly be decided by the Supreme Court in the next few years. Without the individual mandate, it is unclear what will happen to the healthcare reform law.

I hope that by reading through the history of attempts to pass universal health care in America, you also got a sense of what a big deal the passage of the reform bill really was. As Peters states, Presidents since Truman have been trying to pass some form of universal healthcare in America and we are the last developed country without comprehensive access to healthcare. While there is plenty to dislike about the bill from both sides of the aisle and the standpoint of policy effectiveness, sometimes good politics has to be good policy for anything to change. For those of you who watched "Sick Around the World", I hope you saw that relative to the healthcare systems of other countries, the system created by the healthcare reform bill is still quite ideologically conservative and market-based.