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Monday, October 13, 2014

Why We Need a National Health Service

The Constitution was designed for a Networked but Federated system for responding to national threats. The founders divided into groups around George Washington, who would prefer a National Military ("Continental Army") and others who wanted more localized militia. But they all agreed on the need for collaboration and coordination. They just weren't sure on how to achieve that goal as militia forces had weaknesses in training and discipline and were not always effective over trained, disciplined "professional" forces like the infamous redcoats we fought during our revolt from Britain. The constitution spells out the powers of congress on our national operations including the duty and power to organize arm, and discipline a national militia.

Clearly the Federal Government is responsible for defending the country from all threats. And the founders clearly envisioned a medical component for the militia, though the science of health and the military was in it's primitive state when the constitution was written. Folks defending the Affordable Care Act were able to cite the 1792 Militia Act which mandated that militia members provide their own arms and the Seamans Act, which mandated that Ships carry insurance on seamen.

But I'm not defending private solutions for our health care issues. The authority for the arms requirement of the USA militia is in Article 1 Section 8 of the constitution as well as the commerce clause. I'm citing these because it is clear that the principle of Federalism involves collaboration and cooperation directed from a general staff with consent of legislatures and local government -- and that has been focused on national services from the beginning of our country. We need a National Health Service organized along militia principles.

Article 1 Section 8 Militia

The Surgeon General is an old position. He should be the Article 1, Section 8 head of a National Health Service Militia which should be the organizing, provisioning and disciplining body for that service under the supervision of congress. The Surgeon General should also be responsible for governing such part of them as employed in the Service of the United States. It should have 50+ membership branches (with intermediate administrative branches by region for organization purposes) with each member at the employ of the States. This National MHS and it's officers and education should be shared collaboratively between the member governors and the Surgeon General. The National MHS would have a governors Board composed of delegates from each subdivision and a legislative advisory board elected by general members (interested people) of the MHS.

Such organizations, being collaborative between States and Federal Government would be explicitly constitutional, but including a legislative advisory body within them ensures that Federal principles are replicated within the States. To do that right this principle needs to be replicated within each state as well. A section 4 Republican guarantee to every State involves replicating this structure within each State so that Hospitals, Schools, clinics, Towns, Counties and Cities are involved in this system and represented in it's governance.

What is missing from most of our top down bureaucracies is a rational legislature. A principle of good requirements and good lawmaking is involving the stakeholders in making such laws. A legislative advisory organization led by experts and elected representatives of an expert community can provide such guidance in an excellent way. This is what we need to organize our response to both emergency and to budget and policy decision making. Collaboration and bottom up forms to counter the effectiveness and inertia of top down decision making.

I propose that the HS include a HS membership organization (which can be an umbrella with chapters and subchapters) with formal advisory powers. It should be self governing and self-funding through membership or similar fees and independently bottom up run. It would be self governing over those parts of it's membership that are self funding. This would be a formal organization with open general membership and a "bar" of people of good character with voting powers and officer eligibility.

Federal Government as Collaborative Government.

The original vision of the Founders was of a country that would be a collaboration between the states. It also is one of Federalism and Commonwealth. It was not intended to be yet another incarnation of the Top Down bureaucratic Imperium of Rome. It was supposed to be a new idea of a new government that would be as Lincoln said "of the people, for the people and by the people". And we can make it so.


Constitution on militia:

To define and punish Piracies and Felonies committed on the high Seas, and Offenses against the Law of Nations;
To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;
To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
To provide and maintain a Navy;
To make Rules for the Government and Regulation of the land and naval Forces;
To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
To provide for organizing, arming, and disciplining the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;

1792 Militia Act which mandated that militia members provide their own arms:

"Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That each and every free able-bodied white male citizen of the respective states, resident therein, who is or shall be of the age of eighteen years, and under the age of forty-five years (except as is herein after excepted) shall severally and respectively be enrolled in the militia by the captain or commanding officer of the company, within whose bounds such citizen shall reside, and that within twelve months after the passing of this act. And it shall at all times hereafter be the duty of every such captain or commanding officer of a company to enroll every such citizen, as aforesaid, and also those who shall, from time to time, arrive at the age of eighteen years, or being of the age of eighteen years and under the age of forty-five years (except as before excepted) shall come to reside within his bounds; and shall without delay notify such citizen of the said enrollment, by a proper non-commissioned officer of the company, by whom such notice may be proved. That every citizen so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch with a box therein to contain not less than twenty-four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball: or with a good rifle, knapsack, shot-pouch and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear, so armed, accoutred and provided, when called out to exercise, or into service, except, that when called out on company days to exercise only, he may appear without a knapsack."

Seamans Act:

In 1790, the very first Congress—which incidentally included 20 framers—passed a law that included a mandate: namely, a requirement that ship owners buy medical insurance for their seamen. This law was then signed by another framer: President George Washington. That’s right, the father of our country had no difficulty imposing a health insurance mandate.[...]
Six years later, in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. That’s right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams.
That's from Einer Elhauge, a professor at Harvard Law, who continues, "not only did most framers support these federal mandates to buy firearms and health insurance, but there is no evidence that any of the few framers who voted against these mandates ever objected on constitutional grounds. Presumably one would have done so if there was some unstated original understanding that such federal mandates were unconstitutional."

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