Where should conservatives turn for new leadership on health care issues during the Obama years?

Certainly one place should be the executive mansions in the states. Gov. Bobby Jindal of Louisiana and other like-minded reformers in the states are working to implement practical reform programs based on markets and consumer choice. That’s the subject matter for this piece, posted yesterday at National Review Online:

[Jindal] recently released an ambitious plan to reshape his state’s Medicaid program and expand coverage to a large segment of the state’s uninsured. The details of Jindal’s plan reveal a rare understanding of a central failing of today’s arrangements: Government-run fee-for-service-style insurance, as practiced in current Medicare and Medicaid, is the primary cause of low quality, fragmented, and inefficient care — in Louisiana and everywhere else.

Jindal wants to tackle this problem head-on. He would restructure Medicaid by moving toward fixed-dollar entitlement and consumer choice. Medicaid recipients in Louisiana would be given the power to select from among a number of competing networks of doctors and hospitals. The state would pay these networks a monthly fee intended to cover the costs of all necessary care, instead of a fee every time a beneficiary used a service. The expectation is that health-care practitioners would be forced to rethink how they do business to find innovative ways to keep people healthy and well — and out of the hospital. Physicians and hospital administrators who believe they can provide better care at less cost would have a strong financial incentive to jump into the reformed Medicaid program, because they would share in the savings from improved productivity.


December 10, 2008