Cuccinelli on Health Care Reform

Primum non nocere

by James A. Bacon

In his book “The Last Line of Defense,” Attorney General Ken Cuccinelli delineates his constitutional views as the state’s top lawyer and he opines on the philosophical principles that undergird his approach to public policy. But he provides few specifics on how he, as the presumed Republican candidate for governor this year, would govern if elected. Laying out a campaign platform was not his intention, of course,  as the book is not a campaign document but a description of how he and other Republican AGs fought the Obama administration’s unconstitutional erosion of state sovereignty.

However, we do get a glimpse of Cuccinelli’s thinking in one realm, that of health care. Because so much of his book is devoted to his legal battle against the Patient Protection and Affordable Care Act (Obamacare), Cuccinelli digresses briefly to discuss how to reform Virginia’s health care system if Obamacare were rendered ineffective by state action (by opting out of the Medicaid expansion and the set-up of a health insurance exchange).

As it happens, Cuccinelli’s views on the subject coincide largely with my own: First do no harm. The current system of health care in the United States is a mess, he writes. But the answer is not giving government more power. In effect he subscribes to Bacon’s axiom of political reform: Before you create new laws, regulations and programs to fix what’s broke, un-do the laws, regulations and programs that broke it in the first place.

The book treats us to no more than a bullet-point description of Cuccinelli’s market-based remedies but the proposals are suggestive. At the federal level, the AG would allow the purchase of insurance across state lines, give individuals who purchase their own insurance the same tax status as employees who purchase it through their employers, and incentivize the use of Health Savings Accounts.

That’s all fine and good (and pretty standard fare), but the governor of Virginia doesn’t have much influence over federal law. Within the realm that governors can control, Cuccinelli would:

  • Roll back the mandated benefits required for the purchase of private insurance plans;
  • Eliminate restrictions against the purchase of health insurance across state lines (presumably by means of interstate pacts);
  • Require transparency in pricing without which it is difficult for consumers to exert meaningful influence in health care markets; and
  • Put caps on malpractice liability.

I am comfortable with the first three measures but believe the fourth to be superfluous in Virginia, given the fact that the commonwealth’s malpractice laws are pretty reasonable to begin with. Also, I believe the list of needed reforms is only partial. Others include: (1) The state should create more than transparency for prices, it needs to create transparency for risk-adjusted medical outcomes, too; (2) the state should eliminate Certificates of Public Need, which restrict competition between health providers; (3) the governor should use his bully pulpit to encourage (not coerce) hospitals, physicians and other providers to embrace best practices that boost productivity and improve the quality of medical outcomes; and (4) the governor should establish the goal (a tall order, admittedly) of making Virginia the healthiest state in the country by means of such strategies, highlighted on this blog, as creating more walkable/bikeable communities, encouraging the consumption of more nutritious food, and working ceaselessly towards the goals of cleaner water and cleaner air.

I don’t sense that Cuccinelli has given these matters anywhere same the amount of thought that he has to the constitutional issues arising from Obamacare. But if he wants to govern well – and persuade others that he can govern well – he would be well advised to flesh out his ideas.

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10 responses to “Cuccinelli on Health Care Reform”

  1. reed fawell III Avatar
    reed fawell III

    Excellent post –

    I am getting the sense that this fellow Cuccinelli is a serious fellow – far more than your all too typical empty suit politician –

    Seriousness is of course is an important quality in any leader, irrespective of whether or not one might disagree on any issue or cluster of issues. At least this fellow appears to be trying to deal in a serious way with real problems. Or that’s the sense one gathers from these Bacon Reports on the guy’s book.

  2. pretty clear that the Cooch is an ideologue here.

    “Roll back the mandated benefits required for the purchase of private insurance plans;”

    how will he do this? Does the Cooch plan to become Gov and then use the AGs office to go after the Feds? This is a state priority?

    “Eliminate restrictions against the purchase of health insurance across state lines (presumably by means of interstate pacts);”

    so the Cooch is going to try to get with 49 other states to accomplish this? Will he need approval from the Feds for an Interstate Compact?

    “Require transparency in pricing without which it is difficult for consumers to exert meaningful influence in health care markets;”

    so the Cooch is going to use Big Govt tactics to tell private companies what to do ? so he’s actually advocating doing the same thing he
    says he’s going to oppose the govt for telling insurance companies what they have to offer in their coverage?


    Put caps on malpractice liability.

    Virginia already has caps on liability, right? Would this be helping citizens or helping those who malpractice?

  3. How did we conclude that this book “is not a campaign document”?

  4. my thought also. how is that book NOT a campaign instrument? Are we expected to believe that the timing of it – with the Cooch knowing his own personal ambitions was purely coincidental? What is in the book is not what he would do as Gov?

  5. Let’s put it this way — the book has none of the trappings of a campaign document. It keeps a tight focus on Cuccinelli’s fights with the Obama administration, mainly legal and constitutional issues of zero interest to most people. He never talks about his upcoming governor’s race. He doesn’t lay out a campaign platform. He doesn’t dish the kind of dirt that generates a lot of news stories. He doesn’t cater to electoral constituencies. It’s not a campaign document.

  6. Peter Galuszka Avatar
    Peter Galuszka

    There are a few small points about your interpretation of Cuccinelli. (By the way your headline on the first book posting about “being Tea Party before the Tea Party,” is a direct lift of my quote of Paul Goldman in my story about Cuccinelli in Style Weekly. Better watch that plagiarism, Boy!).

    The fundamental problem I have with you review and blogs on the Cooch book, which I have not read since I am not on the favored bloggers early distribution list.

    You state: “The book chronicles the struggle of the AG and his conservative peers in other states against the Obama administration’s unconstitutional power grabs in pursuit of an expansive, big-government agenda.”

    Then you talk about this network of conservative attorneys general becoming an important and unreported political force.

    A few problems with this. First, you are wrong about the Obama Administration making an “unconstitutional” power grab and the Affordability health care act (ObamaCare). Maybe you were out of town, but the U.S. Supreme Court last summer upheld the vast majority of it. So, why is it “unconstitutional?”

    Secondly, the EPA, under various federal pollution laws, DOES have the right to set regulations to contain harmful water and air pollutants. Check out NEPA, the Clean Air and Water Acts,m RCRA, etc.

    Thirdly, the NLRB labor deal (haven’t read the book) deals with the Boeing case in South Carolina, right? So that’s ONE CASE. Meanwhile this devastating threat to our freedom and style of government is somewhat overshadowed by the fact that the percentage of workers enrolled in labor unions is at a 60-year-low. So even if you buy that the South Carolina case was wrong and evil, where, exactly, is the threat to federalism?

    Lastly, if Cuccinelli is so profoundly worried about everyone’s rights, why would be not support protecting gays hired by state universities? Why is he trying to make as hard as possible for women to have a legal and constitutionally-approved abortion? Don’t they have rights? Or dos he fight for rights selectively?

    It is incredibly obvious (except to you) that the Cuccinelli camp is cherry picking his campaign points and throwing the inflammatory ones down the memory hole. You let him get away with this.


    1. If Cuccinelli had written a book about guns, gods and gays, I probably would have had a very different take. But that’s not the book he wrote. He doesn’t touch upon culture-war issues at all. You can disagree with his position on abortion and gays, but they are not constitutional in nature. This book was about defending the constitution.

      As for the Supreme Court upholding Obamacare, it held that the individual mandate was a tax. It struck down the Obamacare mandate that would have imposed the Medicaid expansion.

      You can disagree with Cuccinelli that Obama’s aggressive expansions of federal power were unconstitutional, but there is no disagreeing with the fact that Obame has aggressively expanded federal power vis a vis the states. Of course, that’s fine with liberals, who crave a strong central government that can impose their views and values upon others. But that’s not fine with the rest of us, who don’t like having liberals’ policies shoved down our throats.

    2. Regarding the headline… When I was posting the blog, I remembered the line… I just couldn’t remember where I’d heard it. Thanks for reminding me. I give you and Style full credit.

  7. Obama cannot “expand power”. He is limited by the laws and by the SCOTUS.

    To characterize his actions as “unconstitutional” is to repeat the words of an ideologue and to repeat them here is basically agreeing to his wrong characterizations and yes, it IS a campaign document because THIS IS THE PHILOSOPHY that he WOULD BRING to the State as Gov.

    This says reams about how he would govern. There is no honest way to dance away from that.

    As long as substantial parts of the GOP walk, talk and think this way , there is no hope for any kind of compromise approach to going forward.

    Sooner or later, enough people are going to realize that the hard-right GOP has no intention to seek a middle ground on governance.

    They refuse to deal with the realities of the demographics nor the necessity to acknowledge than the POTUS is the POTUS no matter how much you disagree with the results of the election.

    for the next 4 years, from the right, this is the kind of dialogue we can expect… claiming the POTUS is assuming power he does not have, when, in fact, he does – Congress has given it to him and the SCOTUS has certified the Constitutionality yet the GOP will simply believe what they wish to believe. This is how delusional they have become. It’s as if they just simply deny the election.

  8. Peter Galuszka Avatar
    Peter Galuszka

    Correcting myself. I believe it was Bob Holsworth, not Paul Goldman who gave me the Tea Party quote.

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