Republican presidential candidate Sen. John McCain surprised virtually everyone when he picked Alaska's Gov. Sarah Palin as his running mate.
Gov. Palin has a remarkable personal story, and America is only now becoming acquainted with her and her views on issues of national and international importance. Of particular interest to Nashvillians will be her views on health care.
The presidential candidates' views on health care are markedly different. Sen. Barack Obama, the Democratic nominee, favors expansion of the SCHIP program and the Democratic national platform includes references to Medicare for all and national choices equivalent to the federal employee health benefit program.
In contrast, Sen. McCain favors decoupling health insurance from employers and overriding the 50-state regulation of health insurance, creating a national market for health insurance. Added to the debate is Gov. Palin, a historic advocate of market-based health reform. In her first year as governor of Alaska, Palin convened a task force to stimulate market-based health reform. Among its recommendations, the task force suggested creating a state office that would provide consumers with information on price and quality.
This recommendation mirrors the policy recommendations of U.S. Department of Health and Human Services Secretary Mike Leavitt and the Bush administration.
Palin's task force also suggested the more controversial recommendation of abolishing the state's certificate of need program. In her state of the state address, supporting the proposal to end the certificate of need program, Palin argued "health care should be in the hands of doctors, not lobbyists and lawyers."
The proposal has not passed the Alaskan Assembly, and appears unlikely to do so.
Do certificates fill need?The National Health Planning and Resources Development Act of 1974 established federal funding for state health planning agencies in an effort to address rising health-care costs. The idea was that state health planning agencies would assess health-care needs in each community and approve new or improved facilities and equipment only in those areas of genuine need.
Proponents of certificate-of-need laws have argued that excess capacity, in the form of overbuilding, directly results in health-care price inflation. However, critics have argued for years that health planning does more to restrain competition than it does to reduce costs. The federal requirements for health planning were abandoned 20 years ago; however, many states, including Tennessee, have maintained their certificate-of-need programs for compelling reasons of public policy.
McCain has become an advocate of abolishing state regulation of health insurance. It will be interesting to see if his running mate persuadeshim to extend the abolition to state certificates of need.
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