In Tuesday’s post about the Graham-Cassidy health bill, I argued the biggest gain from passing the bill would be shifting more health policy out of the federal level, where it is destined to remain intractably contentious, to the states. Turns out, that’s the most preferred option for the public as well.
One of the findings of a new poll for Morning Consult and Politico is that Americans generally don’t want to give more control over health care to the private sector or the federal government. But they do generally support giving more control to the states. Here’s the breakdown:
- On whether they generally support giving more or less control on the health-care system to the private sector, 28 percent said more and 32 percent said less — a gap of minus-4 points.
- Regarding the federal government, 26 percent said more control and 39 percent said less control — a gap of minus-13 points.
- Regarding state governments, 33 percent said more and 27 percent said less — a gap of plus-6 points.
The federal government was also the least likely to have respondents say it should have about the same amount of control it has now: just 21 percent, compared to 24 percent for the private sector and 26 percent for state governments.
The cross-tabs show why the latter is likely the only change of direction that would prove durable. Poll respondents who identified themselves as Democrats were minus-27 points on giving more control to the private sector and plus-13 points on giving more control to the federal government. Self-identified Republicans were the opposite: plus-20 points for the private sector, and minus-37 points for the federal government. In both cases, an ideological predisposition to each option is strong — there’s more than a 45-point swing between the parties on each of those choices — and unlikely to change. (Independents were down on both options: minus-4 for the private sector and minus-17 for the federal government.)
But when it comes to giving more control to the states, all three groups were positive: Democrats plus-9, independents plus-6, Republicans plus-5. It was the preferred option of those who say health care is their No. 1 issue, and it was the top choice in all four regions of the country (Northeast, Midwest, South and West), for every racial/ethnic group, and at every income level except one (those who earn more than $100,000 per year would prefer the private sector take more control).
Given the contentiousness the Obamacare and now anti-Obamacare debates have generated, it’s pretty remarkable to see that kind of consensus for a direction for health-care policy. The bottom line appears to be that people have more confidence in their state governments to do the right thing by them when it comes to health care than either private companies or Washington. As a practical matter, that probably means we would have a mix of states that choose less centralized, more market-oriented systems and states that choose the opposite. Which is probably a better and less volatile outcome than trying to make 320 million people move in either of those directions all at once.
I should note here that Graham-Cassidy does not take a full step in the direction of federalism. Washington would still be distributing much of the money and would retain say-so over how much states could deviate from the Obamacare status quo. The bill would be improved by, among other things, taking away so much discretion for the secretary of Health and Human Services to deny state waivers to Obamacare’s regulations.
But even pointing us in the correct direction makes this bill markedly better than what we have now.