The first Health and Human Services panel on Sunday, Governance and Healthcare: Who Decides?, was as much about decision-making in our federal structure as it was about health care. Leo Linbeck III, president and CEO of Aquinas Companies, kicked off the conversation by arguing that our current system is skewed in favor of a centralized federal authority and that the Affordable Care Act is just one example of how far removed decision-making is from the people those decisions affect. For a while the audience and panelists danced around the issue until moderator Emily Ramshaw of the Tribune noted that the alternative to federal authority is often state authority and asked rhetorically “how much do you trust Texas?”

Arlene Wohlgemuth, director of the Center for Health Care Policy at the Texas Public Policy Foundation, made another notable argument during Sunday’s first panel. She asked another panelist what makes health insurance so different from any other item out in the marketplace that the federal government should be allowed to regulate it. The argument goes, if the federal government can mandate the purchase of health insurance why not the purchase of other goods and services? Sunday’s keynote speaker took this argument head-on.