A single national market for health care

It would be a national market with a single standard for malpractice, writes Gail Russell Chaddock, with tax credits to push people into the insurance market.

In theory these are great ideas, even if they do turn 100 years of Republican orthodoxy on its head. Out with state control, in with national standards. Ronald Reagan would roll over in his grave but it might bend the cost curve.

Fact is there is no U.S. health insurance market. There are 50 state markets. And there is no U.S. health care market. There are hundreds of local markets.

Unless you get a dire diagnosis with the time to seek innovation wherever it exists you are unlikely to go outside your home town for care. And the policy you buy is governed entirely by your own state's laws, not its' neighbor's.

If you live in El Paso, Texas we will pay much less for your Medicare care than if you live in McAllen, at the other end of the Rio Grande Valley. How do we build competition between low-cost and high-cost centers of medicine? It's a question worth examining.

The problems of insurance and malpractice are more difficult. The practicalities look daunting.

• How do we eliminate 50 state insurance departments, each with their own standards for care, payment, and the financial soundness of insurers?
• How do we overthrow 50 different sets of precedents on medical torts -- do we move all the cases to federal court or just wave a magic wand?

These are difficult questions, but questions worth pursuing.

The Administration wants data to tell McAllen what El Paso is doing right, so McAllen can improve its cost-effectiveness. But doctors in McAllen insist there are no real differences. The markets are different, the people in McAllen much sicker.

The structure of those markets is also different, with doctors owning much of the medical infrastructure in McAllen, very little in El Paso. Should we have one standard for a market structure? Maybe we should, and one standard of care on which insurance will pay one schedule of charges.

In truth some Democrats see the broad sweep of Republican ideas, and their challenge to their own party's orthodoxy, as proof the party is not really serious about reform. Where was the progress in these areas when Republicans were in charge, they ask?

Still, the ideas are worthwhile. Democrats should ask Republicans, in the words of tennis great John McEnroe, "Are you serious?"