What would need to happen that insurance companies could compete nation-wide instead of being restricted to a single state? Isn't it a state regulation? Would the Federal Government have any power to change it?
In areas where both the federal and state governments can regulate, the federal government can preempt the states. All that needs to happen is for the federal regulation to exist and either 1) be incompatible with state regulation or 2) specifically preempt state regulation.
The states will never let it happen. California loads health insurance providers up with so many regulations that NO ONE in California would buy the California plan if they had another alternative.
You'd need to repeal the 10th Amendment. Something both Democrats and Republicans want, but for different reasons.
Why bother to repeal it? It has been so thoroughly ignored for over two centuries now that no one would even notice another instance or three...
Alexander Hamilton pushing for the creation of a federal bank, even though the Constitution never gives the federal government the power to create, own, or operate a bank (and thus forbids it, according to the 10th Amendment) was much more than 1½ years ago. His reasoning (since labeled the "Hamilton Doctrine") was that since he thought that would be a good way of doing some of the things the federal government does have the right to do, it was legitimate. (Which is a blatant logical fallacy. His reasoning would be sound only if that was the only way of accomplishing what the federal government was mandated to do, which it was not.) If Congress, the President or the Supreme Court had insisted, back then, that it couldn't be done because it contradicted the 10th Amendment, that would have set a much different course for the future of the country. No matter how hard you try, you can't lay all the ills of the country at Lincoln's feet, or the leaders of the Civil War period. They were simply following in the paths set out by those who preceded them, taking them to their logical conclusion. The fault lies at least as much, if not more, with those who set the country on those paths in the first place. I maintain that the 10th has been ignored for over 2 centuries.
Strictly, it's the one matter that both parties are happy to appropriately leave to the 10th amendment and a strict meaning of the interstate commerce clause (the road to where, exactly, is paved with bad intentions?). The Federal government has no power to change it except through the practically dubious means of withholding funds for something if the states don't repeal the restrictions themselves. I say practically dubious because if they try it, the insurance companies will covertly fund a campaign to discredit the practice, and will probably win, leading to a net loss of power for the Feds, a lose/lose situation for those in power, corporate and government. That's obviously unacceptable, and an amendment is pretty much unthinkable, so the status quo will remain indefinitely. Sorry, I'm a little cynical tonight. My normal response would be "A Constitutional Amendment, which seems unfortunate in this case, but the road to hell is paved with good intentions, so let's try to avoid giving the Feds any more power than is absolutely necessary."
Surely you're not suggesting that congress use the commerce clause to promote COMMERCE!?! That's just crazy enough to work!
