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How far Government?

In a democracy devised on a careful separation of powers, the US health-care reforms advanced by this US Administration (Obamacare) opened a battleground where opposing views of Democrats on centralization of government collide with Republican doctrines on decentralization of power.

Utah’s Conservative health-care reform

Is it a better answer to the health-care question?

May 26.─ Gary Herbert the governor of Utah, loathes everything about Barack Obama’s health-care reforms, not least, he says, the way “Obama has come along and spoiled the name ‘exchange’.” After all, Utah conceived its own version of health reform, called the Utah Health Exchange, long before Barack Obama signed his Patient Protection and Affordable Care Act in 2010. Utah’s reform is “market-based”, says Mr Herbert, whereas “Obamacare” is a big-government monstrosity. But it too relies on exchanges, so now the word is tainted. Republican governors in New Mexico and New Jersey have even vetoed attempts by their legislatures to build health-care exchanges.

For Utah this means that its reform needs a new brand name. “We’ll have a contest,” says Mr Herbert. Beyond that, Utah will continue its fight, with 25 other states, to get Mr Obama’s reforms repealed, something that could happen as soon as next month, if the Supreme Court rules against them. But however that turns out, Utah will push on with its own reform, because “we think it’s really cool,” and a potential model for the other 49 states, says Norman Thurston, the man chiefly responsible for getting it up and running.

The history of the Utah Health Exchange is a reminder of the bizarre, tangled genealogies of America’s various health-care reforms. Utah’s was nursed into being in the past decade when Jon Huntsman, a Mormon Republican, was governor. At that time the main alternative reform was being cooked up in Massachusetts by its then-governor, Mitt Romney, also a Mormon Republican. Both men advocated a “mandate” that required everybody to buy insurance, an idea that originated in a conservative think-tank. But Mr Huntsman and Utah subsequently dropped that idea, whereas Mr Romney held on to it. Since then, and unexpectedly, the notion of mandates has become toxic in conservative circles.

Utah also decided that government subsidies should play no part in its reform, whereas the one in Massachusetts was based on them. Thus Mr Romney’s plan became, more or less, the basis for Obamacare, whereas Utah started seeing its plan as a free-market alternative …

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