Monday, December 28, 2009

Skepticism about centralization of power, healthcare reform, state governments

The recent health care bill has got me thinking. Although universal health care is a great thing, I would also be somewhat skeptical about the desirability of strengthening Washington DC even further. So what could be done? Well, one thing that I'd like to see is a return to power of the state and local governments, with a lot of the power that DC has currently devolving back onto them. These state governments would exist in a sort of confederation that could meet to agree on common standards and practices. Instead of one centralized health care bureaucracy you'd have fifty state administered health care plans that would most likely be 95% similar to each other. We could push for something like this in the mean time by just using the powers in state government to try to accomplish something along these lines, on a more limited basis. This would mean engaging with the State somewhat, but engaging with it in a way that would be somewhat more controllable than DC is. A push to the regional and to the local would be a natural complement to this. However, just a word there: if local is going to go anywhere it has to break out of ghettoized alternative communities and work with a broader range of folks. That said, some sort of devolvement of power in the way I'm describing would take a constitutional change to accomplish. But I still think that working from the bottom up we could do a lot, if we keep our eyes on the prize.

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