States Rights and Health Care

By on November 3, 2012

Mr. Romney the Republican candidate for President has turned into a real ‘States Righter’ since becoming a senior  citizen. His philosophical awakening extends from health care to emergency relief efforts. It is hard to understand.

States Rights is a position taken by both Conservatives and Southerners in the past Century. After the founding of the Republic, some of the leaders of the Revolution wanted a weak central (Federal) government with more of the power located at the state level or not at all. Two issues drove the debate, taxes and slavery. Before the Constitution was written, we functioned under Articles of Confederation that required the Federal Government to go hat in hand to the states on most issues including money for national defense or just inter-state conflict. Wiser minds then realized the danger of a weak, begging central government and pushed through the Constitution and a more balanced approach.

John Marshall

Ironically it was not the Conservatives of the day that worried most about Federal authority, but Jeffersonian Democrats who felt the idealistic rural interests needed protection from the iron-fist of power-hungry rulers in the nation’s marketplaces. The Constitution was a compromise both sides could live with. Slavery of course was never mentioned in the document, being a deal-killer of the times.

In 1814 Chief Justice John Marshall took advantage of the case Marbury vs. Madison (Madison being the President) to assert authority for the Supreme Court to interpret the laws of the land as to their ‘constitutionality.’ Madison, one of the framers of the Constitution, and the winner in Marbury, did not object. Neither did Congress.

In the years that followed, the Supreme Court set the standard that what was not explicitly mentioned in the Constitution as belonging to the authority Federal government was the provenance of the states. Among those other things were emergency disaster relief, and health care. In those days the cost of health care was miniscule because there was little doctors could do for sick patients but comfort them. Charitable work by churches picked up what little cost existed. Alms houses housed the sickly poor. A national calamity would also have called forth local charitable efforts.

Earl Warren

In the years that followed, states rights became the rallying cry of the Slave States and then the Southern States fighting Integration. In the twentieth century it also surfaced in disputes about interstate commerce and New Deal programs. The country edged toward greater unity on a national level as communications became more and more sophisticated. In 1954 Brown versus Board of Education dealt a death-blow to the separate-but-equal arguments of States Righters for Segregation. Chief Justice Warren coerced a unanimous opinion in the case, and President Eisenhower enforced it.

So why are we hearing about States Rights now in the health care debate? A heart attack is a heart attack in each of the 50 states. The treatment of medical realities are a national issue. There is no Tennessee  approach to Hodgkin’s Disease, no Idaho methodology for delivering a baby. Each nationally accepted treatment is founded on scientifically measured outcomes  and clinical experience.  Following these standards is required by every Medical Board and the Joint Commission and every other regulatory agency at work.  Any variation must be backed up by medical experience or research.

The legislature in Texas doesn’t argue about whether an abdominal approach or a pelvic approach is best for a given case of ovarian surgery. Nor should they. Sending the responsibility for financing and over-seeing medical care to each individual state, and then throwing some variable amounts of Federal money after it is a ludicrous suggestion. No one in their right mind would want that kind of care. Mr. Romney certainly knows better as a governor who devised major state reforms in health care. He needs to stop ‘lifting his skirts’ for every interest that comes along waving money.

We can all impacted by natural disasters like Sandy or Katrina or 9/11. Fate rolls the dice. It should not be up to each state to fend for themselves. Epidemics are the same, whether it be avian flu or just rampant obesity. We need uniform compassionate approaches to these national problems based on science and actual experience. These are not issues for States Righters. That approach should have been buried with Jefferson Davis.


Tom Godfrey

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