I think Ashton’s blog post yesterday, suggesting that we replace Obamacare with a too-little-hyped proposal from GW Bush, was very much on target. I would add, however, that there are other things that could be added to Bushcare that would make the proposal even better. First, there’s the old stand-by proposal, no less important for being old, to allow health insurance purchases across state lines. Second would be to adopt other proposals mentioned in the Bush plan, which Bush supported but that weren’t technically part of the plan, such as medical liability reform and allowance of Association Health Plans. Third would be a version of Paul Ryan’s proposal to block-grant Medicaid to the states — but with a twist: The original grant amount should exceed the current amounts going to the states, but then save money over the ten-year time frame (as in the Ryan plan) by capping the amount with smaller adjustments than current health-cost inflation. The idea would be to achieve the savings in the years beyond year ten, while really giving states the chance to make expensive up-front investments that many state-level reforms would require. and that would both save money and improve health-care delivery for poor people in the long run.
The model for this would come from an experience Louisiana had in the 1990s, when the feeds (rightly) closed a loophole Louisiana was exploiting, but the closure of which would have bankrupted the state if the closure was implementing immediately. The then 25-year-old director of the Louisiana Department of Health and Hospitals, one Bobby Jindal, showed fed officials a way the law could allow added payments in the first two years in exchange for lesser inflation adjustments later, all for a net even total expenditure — but in a way that let the state buy time to implement a series of reforms Jindal was pushing.
Anyway, with those additions, I completely agree with every word of Ashton’s post.