July 20, 2012 09:15 AM

The Supreme Court’s decision essentially upholding the Affordable Care Act presents a challenge to Mitt Romney and others promising to “Repeal and Replace Obamacare.”  The question is: Replace it with what?

Missouri and the other states that have adopted the Health Care Compact have already answered that question.

The Health Care Compact returns authority over health care to the states. It is an interstate compact that requires congressional approval, and with that approval will come block grants to states at the same level of spending now exercised by the federal government.

States will be free to choose different solutions that best suit them. Massachusetts could require residents and businesses to purchase private insurance, while Vermont might opt for a single-payer program, and Texas could choose a market-based system. Indiana, South Carolina, Utah, Georgia, Texas, Missouri and Oklahoma have already adopted the Health Care Compact.

Returning health care spending and policy details to the states also solves a larger problem that has bedeviled the system. Our health care problems cannot be solved as long as decisions about them are made by politicians, bureaucrats—and yes, even Supreme Court justices—at the federal level in Washington, DC.

That’s because the most urgent problem is one of governance—the question of: “Who decides?” We must fix the governance problem of “who decides” before we can fix the policy problem of “what is decided.”

America faces an epic crisis of governance on the issue of health care. Congress has spent decades gradually grabbing power over most of the health care system, and it capped off their project with Obamacare.  No Congress can handle such responsibility well. There can be no centrally controlled health care system consistent with a free and independent American republic.

The ACA is a radical governance power grab breathtaking in cost and scope.  The law does not define what type of healthcare will be provided, but it does identify who will decide: federal bureaucrats.

The only effective counter to this is sweeping governance reform, returning authority over health care to the states as the Health Care Compact does.

The Health Care Compact differs from other alternatives being discussed. The Ryan Plan for Medicare and Medicaid reform— supported by key congressional leaders from both parties—is better than Obamacare but, is still based on the flawed notion that solutions to our problems are to be found at the federal level.  The Ryan Plan, like Obamacare, leaves Congress at the center of power.

America’s founders recognized dispersed authority and an engaged citizenry as the essential anchors of a free country. James Madison in Federalist No. 57 defended the new Constitution not by pointing to federal judges as guarantors of liberty, but by highlighting “above all the vigilant and manly spirit which actuates the people of America, a spirit which nourishes freedom, and in return is nourished by it.”

When Mitt Romney and others promise to replace Obamacare, they can also restore the Federalist foundations of our Republic.  Missouri already has approved a clear alternative to our centralized health care system - the Health Care Compact. It is the way to replace Obamacare while living up to our ancestors’ hopes and applying their traditional values of self-governance to modern America.

Representative Eric Burlison is a Republican representing the 136th District in Missouri.

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Our health care problems cannot be solved as long as decisions about them are made by politicians, bureaucrats—and yes, even Supreme Court justices—at the federal level in Washington, DC.

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