I find it a bit amusing that the two Republican politicians I invariably see described as “smart” — Eric Cantor and Bobby Jindal — both hail from major stereotypically smart ethnic groups. So I’ve been asking conservative friends and acquaintances if there’s actual evidence that Cantor is smart aside from the fact that he’s Jewish. They all assure me there is.

Jindal, though, is bringing the evidence the hard way by proposing a substantial reform to Medicaid that, if it works, could be a model for further things to come. Per Ezra Klein’s description:

The details remain a bit sketchy, but the basic idea seems to be that he’ll move Medicaid patients — and a fair number of the uninsured — into managed care plans that would receive a fixed rate per patient (the rate would vary with health status). That would eliminate the perverse incentives of fee-for-service care, presumably. But in order to ensure high quality outcomes, there would be financial incentives if physicians met certain performance criteria. Medical homes and more coordinated care would be a major part of the transition.

This is quite different from the current conservative vogue for slapdash efforts at “consumer-driven” health care and is aimed, instead, at delivering better health care to people by, to coin a phrase, experimenting with socialism. This is easier to do, ideologically, for a conservative because Medicaid is obviously already a government program so simply shifting its structure in a more socialistic direction doesn’t carry the stigma that creating a new socialistic program would. But if it can be implemented and it performs well, that could clearly lay the groundwork for future expansions of program eligibility, for structural reform to Medicare, for parallel reforms in other states, etc. It’s not a plan that offers the prospect of the sort of short-term system-wide reform that most health care advocates are looking for, but if a workable plan can be developed it has a ton of long-term promise and is compatible with the kind of things progressive reformers are trying to do at the federal level.


On the other hand, Igor Volsky observes that the somewhat vague description is also compatible with some pretty bad scenarios depending on how exactly this outline gets filled in.