The point of a national debate on health care is to improve health care. It’s not working. Worse, it’s adding so much uncertainty to the system to be counterproductive.

The spear tip of the debate is over a single-payer or similar program, such as the Affordable Care Act, which established the federal government as the overseer and manager of health care.

ACA, or Obamacare, has been largely defanged but it hasn’t gone away.

President Trump devoted a big portion of his State of the Union address last week to health care, mostly focusing on important but very specific programs. Neither single-payer nor Obamacare came up.

Fair to say that Senate and House members left the speech as divided as when it began. Democrats largely favor a single-payer system modeled after the socialized medicine in most Western European countries.

Last week, Will Humble, president of the Arizona Public Health Association, delivered an address focusing on the legal uncertainties of health care delivery. In a nutshell, it’s hurting public health efforts, he said.

A glaring example is insurance coverage of pre-existing conditions. Trump says his administration assures it, a claim rightly refuted by those who say that Obamacare protections haven’t been replaced with new law.

A bill in the Arizona Legislature would mandate coverage for those conditions as a backstop to the murky federal requirement.

Before Obamacare, states handled those and other decisions relating to health care delivery. It was far from perfect but it was better than the current legal quicksand. There are decent arguments in favor of single-payer programs, which in theory should work fine to improve health care access. The overriding arguments against those programs are inflated costs, lack of quick access and personal control of health choices.

These discussions and decisions, including single-payer programs, need to return to the states. If certain heavily Democratic states decide they want single-payer or state-run health care, they can have it. If those programs work, they’ll be adopted elsewhere.

Of course, they will bankrupt states so it’s good if states aren’t required to join in.

The federal government is good at running some health programs, such as immunizations against flu and other outbreaks. It’s not so good at overall health care delivery. We hope that Obamacare winds up dead in the water as a result of continued court rulings and that states continue to address health care issues that are important in those states.

— Today’s News-Herald

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