Government has long played a role in education. The Founding Fathers, particularly John Adams, believed public education was necessary for a functional democracy. Somewhere along the way, free education for all transitioned from a benefit to democracy to a right.

Now, 240 years after the country’s founding, we have a huge public school infrastructure in America. Unlike most government programs, however, public schooling is largely not centralized in Washington, D.C. Washington does play a role, but for the most part local governments are in charge of education at the grade school level.

Some local governments do an awful job. Others are great. It mostly varies along the lines of income and what a local government can collect in taxes (also interested and involved parents, but that is for another day).

Like education, a more recent development is the sense health care is a right in this country. A lasting consequence of Barack Obama’s presidency is the apparent national conviction everyone is entitled to health care, much like education, regardless of income.

That obviously means those who can pay more will have to pay more in order to cover someone who cannot. The “from each according to ability to each according to need” for health care.

The reality is that this system as it is currently constituted is not sustainable.

When Obama signed the Affordable Care Act into law on March 23, 2010, it set in place a mandate requiring Americans to have health insurance or face a penalty. Some would have to pay more than others because under this system, the government would offer you a subsidy based on your income.

Even with all this government interference, the market still reigned supreme. A hybrid government-private health insurance company, Frankenstein creation is simply not feasible.

Some health insurance companies are no longer participating in “Obamacare” in some states and customers no longer have options.
It is time to rethink the role health insurance companies play in our health care system.

What we have learned in the early days of this post-Obama era of government, in which the Republicans control both chambers of Congress and the White House, is we’re never going back to the health care system of pre-March 23, 2010.

We can argue the merits of doing so, but the reality is there is no political will to repeal the law. The sad fact is government is going to play a role in health care for the foreseeable future.

Thus, we are well on our way to some sort of public health care option. But why does it have to be centrally planned? Why not leave it up to the local governments?

Our public education system is not perfect, but it somewhat gets the job done. Why not set up a similar system for health care?

Sure, there will be some disparities. Wealthier places will have better health care, but it is better than no health care, and you could likely cut out the middleman: the insurance company.

Yes, another public bureaucracy is something to make conservatives cringe. But it is much better than a centralized federal bureaucracy in Washington, D.C. The federal government has tried to do it with the Veterans Affairs Hospital system and failed miserably.

Leaving it up to city and county governments would offer more flexibility and accountability. For example, if the Santa Monica, California, health care system wanted to offer sex change operations but the Mobile County system did not, then that would be a possibility.

And it is not to say the country would eliminate a private health insurance market. Individuals still could have private health insurance plans if they wanted them.

Consider our education system, in which private schools are an option.

As an American, you do not have to send your child to the public school offered by your local government. Sure, you will still bear the costs of that public system. But if you so desire, an employer could offer health insurance that could be used at the private hospital of your choice.

The idea here is to have some sort of public health care option for everyone. In some places, it might be the only option but at least local governments would have some skin in the game. If it were centralized like a European socialist system, you would have teams of unaccountable bureaucrats thousands of miles away.

Sure, maybe you could call your congressman, but there is little even a member of Congress can do to take on a bureaucracy on their own.

However, if you had a governing body, like a local school board, in charge instead that was accountable to the local voters, a VA Hospital-type nightmare would be less of a possibility.

If as a society we have decided health care is a right, then it is time to disassociate health care from health insurance and offer a true public option. Whatever the public option is, a localized public option separate from the health insurance-based system might be the least of all evils.