Question for TN 78th candidates: Healthcare

After last month’s Supreme Court ruling, Obamacare (officially known as “The Patient Protection and Affordable Care Act”) is now the law of the land.   Almost everyone sees it as merely the beginning of actual healthcare reform, not the end.  It is likely to be the most contentious issue of the upcoming legislative session, and no matter what is decided it is likely to leave bruised feelings for some.

In general, government policy towards markets can be divided into three categories:

  1. Laissez-faire (you can chose both what and whether to purchase)
  2. Individual mandate (you can chose what to purchase, but not whether)
  3. Single-payer (you can chose neither what nor whether to purchase)

The laissez-faire approach is usually seen as the optimal choice from markets ranging from oranges to iPods to automobiles, as robust competition usually yields better results at lower costs.

Healthcare has unique differences from other markets which render a pure laissez-faire policy challenging at best.  Put simply, it is difficult to square the laissez-faire philosophy of “if you don’t pay, you don’t receive” with the Christian ethos of the Good Samaritan.  For most people, compassion ultimately trumps capitalism, but the cost for the uninsured must inevitably be paid, and today that someone is either the taxpayer, the insurance holder, or the hospital, but *not* the person receiving the “free” healthcare.

Given the remaining policy options, the Republican party has historically supported solutions based on the individual mandate (prior to its recent Damascas road conversion on the issue at least), and Democrats have supported single-payer solutions.   While the PPACA is admittedly a unwieldy amalgamation of policies, its core approach to the healthcare market uses the individual mandate.

As attempts to “repeal and replace” the PPACA appear increasingly unlikely to prevail, reshaping it at both the state and federal levels appears to be the most probable path towards refining the law.

1.  Do you support/accept the base PPACA plan, or do you think Tennessee should request a “waiver for state innovation” to implement our own alternate healthcare reform plan (single-payer like Vermont, or perhaps a different form of individual mandate such as Health Savings Accounts plus catastrophic insurance)?   What do you believe leads to the best outcome for all Tennesseans?

2. While mostly upholding Obamacare, the Supreme Court struck down the provision allowing the federal government to withhold all federal Medicaid funding towards states that failed to expand their Medicaid program in accordance with the PPACA.  Several Republican states have subsequently promised to refuse additional federal funding to expand their state Medicaid program.  What are your thoughts on this?

Outside those two questions, please feel free to explain your beliefs about healthcare at length.


I am including a graph of the percentage of Tennesseans covered by health insurance.   You can see that it has been trending down for over a decade.  Given a state population of 6.4 million, the roughly 5.5% decrease in the coverage rate between 1999 and 2010 equates to approximately 350,000 Tennesseans who can either no longer get or no longer afford health insurance.  This is equal to the combined population of Knoxville (180,761) and Chattanooga (170,136).

Previous posts on healthcare reform:

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2 Responses to Question for TN 78th candidates: Healthcare

  1. Donnie Kemp says:

    Something must be done about the rising costs of healthcare and the strain that uninsured individuals are placing on the tax system, not to mention, the misuses of our state’s TennCare program. The cure will not be easily found.

    Up to this point, our mostly free-market healthcare system has given us competent physicians at state-of-the-art healthcare facilities delivering the latest medical care. While this comes with a high cost, it has afforded us quality healthcare. My fear is that through Obamacare medical care will be rationed and our nation’s healthcare quality will suffer. Many believe that Obamacare takes away the flexibility for states to encourage healthy behavior and will cost Tennessee hundreds of millions of dollars while not really helping the healthcare crisis in America.

    While it is my hope that Obamacare be repealed, in the meantime, I would advocate Tennessee requesting a waiver based on state innovation and formulate a plan based around a hybrid form of individual mandate without creating hardships on Tennesseans and their small businesses. With that said, so many parameters are set by Obamacare for states wishing to withdraw that it almost recreates the federal exchange on the state level. If Tennessee does nothing, we run the risk of being pulled into the federal exchange created by this new healthcare legislation. I do not want to leave control of Tennesseans’ healthcare to the federal government and would opt for our state creating its own plan.

    Because the Supreme Court struck down the provision allowing the federal government to withhold all funding from states for non-expansion, I would refuse expansion of the state Medicaid program known as TennCare. I am not against the TennCare system but believe that it should not be taken advantage of by those wishing to misuse the system. Any expansion of this program could create even more avenues for abuse.

    While there is no silver bullet or quick fix, something must be done to combat the ever rising costs of healthcare, intrusion into citizens’ medical care and treatment by the federal government, and exploitation of our state’s Medicaid program. I will listen to the healthcare concerns of the citizens of the 78th district and work to find the best solution.

  2. Rick Wilson says:

    With all of the lobbyist and special interest groups involved in this issue, can, or will anything be done about Healthcare?

    I’m not an expert in this issue, but I do remember someone who was. While Running for Governor, then former Nashville Mayor, Phil Bredesen said, that he was an expert at this subject. After all, that is what he did for a living. This is what he focused his campaign on in East Tennessee. After being elected, Governor Bredesen cut 100,000 people from TennCare. You had to be an expert to do that?

    Then he even went out of State ( I think to Minnesota) to the Mayo clinic to be treated for a Tick bite. This, after 100,000 people were cut from TennCare with life threatening diseases.

    I know this doesn’t answer the question. I think, that this will be an unsolved issue for sometime.

    There was one good thing that came out of the Supreme Courts decision on Obamacare. It will be left up to the States to decide to implement it. From what I understand from local news medias is, if Obamacare fully gets implemented, it will bankrupt the State of Tennessee.

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