The bill in the Pennsylvania General Assembly to create a single-payer healthcare system in Pennsylvania is a fascinating document. Not because it is likely to become law. Even if Democrats take the Pennsylvania Senate while maintaining the governorship and House this November – a real possibility – this bill is still dead on arrival.
Instead, what makes this bill fascinating is what it says about the party. Democrats cast themselves as the champions of everyday people while protecting democracy. Their critics say this is a ruse, and instead the party is concerned with increasingly niche interest groups while handing power over to unelected bureaucrats.
Democrats counter that such accusations are nothing more than partisan hogwash designed to gin up right-wing anxieties. If Pennsylvania Democrats cared to read this bill, they would disavow that counterargument and, one hopes, concede that their critics have a point.
There are many ways to dissect this piece of proposed legislation, from its flimsy tax-generating assumptions to the way it restructures Pennsylvania’s healthcare delivery mechanisms. All those warrant attention, but a portion of this bill that has received little consideration is the manner in which this single-payer system would be managed by appointees, and appointees of appointees, who are overseen by committees of committees. While I doubt this is the intent, this would create a massive instrument of government that is shielded from public sentiment and is largely answerable to special interest groups within the Democratic coalition.
To see what I mean, this single-payer system would be overseen by what is dubbed the Pennsylvania Health Care Board. Members of this Board would include the secretary of health and insurance commissioner, as well as 18 members appointed by the governor or attorney general. Sixteen of those 18 appointees must be nominated by designated interest groups, such as organized labor, disability rights organizations, political advocates of single-payer healthcare systems, organizations representing senior citizens and children, legal groups advocating for low-income clients, and experts in racial disparities.
Not a single appointment is reserved for taxpaying Pennsylvanians who would bear the burden of this system. Rather, this law is designed to stack the system with the special interest groups favored by the left.
This Board is to then appoint an executive director who is answerable to the Board and who would be responsible for creating and operating Pennsylvania’s single-payer healthcare system. Given the makeup of the Board, it does not take much imagination to figure out the political priorities of such an executive director.
More fundamentally, this bill would create a healthcare system that is removed from the will of the people, as exercised by our elected representatives, and place a powerful bureaucracy under the control of those who are there to serve narrow political purposes. And do not just take my word for where the ultimate authority would lie. The bill is explicit: the Board “shall have final authority over the activities of the office.”
So much for democracy.
But the bill goes on to layer bureaucracy on top of more bureaucracy.
It would establish a regional division with an unspecified number of regional offices, as well as an administrative division, planning division, information technology division, and quality assurance division. The director of each of these divisions is to be appointed by the executive director with the approval of the Board.
Further, each division director is to establish a “professional advisory committee” to “provide expert advice.” The bill requires that these committees “shall have at least 25% representation from the general public.” Apparently, guaranteeing the general public one-quarter of the representation was sufficient for the bill’s drafters.
It is as though this bill was concocted in a lab to create a labyrinthine bureaucracy that is somehow answerable to no one and everyone at the same time.
Democrats can be the champions of democracy and everyday people, or they can be the party of powerful bureaucracies that serve niche interest groups, but they cannot be both.
Thankfully for us mere members of the general public, this bill gives us the answer.