The NFIB's Health Care Principles, Explained

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Back in December, the National Federation of Independent Business made what at first sounded like a sweeping statement on health care, and perhaps even a reappraisal. The NFIB called its "Small Business Principles For Health Care Reform" "a foundation to address the No. 1 issue plaguing small-business owners" and "the culmination of more than 20 years of research." It sounded like a grand project, indeed.

On second glance, though, the Entrepreneurial Agenda was not impressed. The principles struck me as little more than a recapitulation of long-standing policy proposals that would gut the group health market, topped off with a new call for a health care system that is "universal." I wrote that the proposal read pretty vaguely and wanted things not just both ways, but all ways -- -universal coverage that was somehow affordable but with as little government intervention as possible.

The NFIB, in turn, thought my post was unfair. The organization's senior health care advisor, Bob Graboyes, wrote a point-by-point rebuttal. That turned out to be the beginning of a dialogue: Graboyes recently answered 19 of my questions in an extensive interview by email. It may be the most comprehensive discussion yet published about the NFIB's position on health care.

So who's right? Now you can be the judge -- and, more importantly, you can weigh in. The NFIB claims to represent you (or at least entrepreneurs like you) -- what do you think of its positions? What questions do you have for the organization? For my part, I found our virtual conversation problematic. Graboyes' answers, in my mind, raise as many questions as they settle. However, when I put some of those follow-ups to him, Graboyes declined to respond, citing the constraints of his schedule and the time he had already committed to the project. But he said he'd reconsider if our conversation generated enough interest among our readers. Fair enough: now it's in your hands.

At the end of his comment, Graboyes wrote, "It would help to know where Mr. Mandelbaum's criticisms originate. Is he a single-payer enthusiast? A libertarian? A staunch defender of the status quo? How would he reform American health care -- if at all? Since he provides no alternative vision whatsoever, it's much harder than necessary to engage in a productive conversation." In the interest of productive conversation, I'll report that my views on health care are simple: we are a wealthy country, and we can afford -- and we are obligated -- to provide decent health care to everyone, and we're better off as a society, and as an economy, if we do. As to how we go about it, I'm much less certain. I can say, though, that I don't have much faith that unregulated private enterprise will effect these changes on its own; as I've written before, if the market could figure it out, it would have done so already.

But enough about me. Let's talk about the NFIB. That conversation starts tomorrow.