Will local control lead to better health?
Rather than fighting reform as a public vs. private battle, opponents might want to consider an approach based on federalism.
They will find an ally in Jim Felsen. The long-time public health officer in West Virginia has written a book, ""="">
Felsen argues that rather than creating a new system, local communities should be given responsibility for prioritizing their preventive health needs.
Dr. Felsen calls his page of RSS feeds on health the De-Spaminator and offers a blog called LocalHealthCareReform which argues for his ideas:
Each community is at the bottom of a hierarchal pyramid; individuals at the top decide how each community and each citizen spends nearly every dollar. A valuable lesson of the media reports of the proposal should center not upon whether its projections are valid but whether - if they are - communities can do anything about it. Unless we invert the pyramid, I doubt most can.
Dr. Felsen wants local health boards, which would include patients, to release annual reports on community problems and what is being done about them.
The board would have the power to direct resources to key problems, which vary from place to place. In some areas it might be smoking. In others violence. In others obesity.
It's the focus on local solutions which gives Dr. Felsen's message power.
There are many ways to argue against Dr. Felsen.
- The boards may be seen as another layer of bureaucracy.
- Badly-run communities may have rotten boards.
- Politics might lead to some boards fighting problems (like teen sex) that don't turn statistics around.
- Political borders may lead to board control by powerful groups whose problems differ from those of local minorities.
- Who will choose the board? Where will its power come from?
But once reformers start arguing against Felsen they are no longer arguing about their desire for larger, systemic, national reforms.
Which may be all conservatives need to win the argument.