The Republican ticket this year was notable for refusing to run on any policy innovations or substantive accomplishments whatsoever. In retrospect, most people think that a mistake. And so you're going to see a real effort in the GOP over the next few years to identify leaders who actually understand policy and can neutralize Democratic advantages on bread-and-butter issues. Chief among the prospects is Louisiana's Bobby Jindal, a former Rhodes Scholar and health policy bureaucrat who's taking a
step into health care innovation today with a major proposal to reform how Louisian's Medicaid system works. 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. For a Republican, this is oddly similar to the payment system used by Britain's socialized National Health Service system, which uses fixed pay rates combined with pay-for-performance incentives. And along the same lines, Jindal's lieutenants are describing the plan in terms that could have come from, well, this blog:
"We have a health-care system that doesn't behave like a system, " said Health and Hospitals Secretary Alan Levine, the main architect of the plan. He said the state needs a more coordinated system of care to improve on key health indicators such as the percentage of women on Medicaid who get breast-cancer screenings.
I'd add to this that Jindal does not seem to be going in the same direction as the rest of his party here. This plan focuses on improving the
medical system, not making indviduals more acutely vulnerable to insurance costs. A week or so ago, Rich Lowry was in
The Washington Post touting McCain's unpopular health care plan as one of the few conservative bright spots in the election. Jindal, to his credit, seems to sense that amping up the pressure of health costs is not really where the country's at, but that you can do a lot to cut costs by focusing on doctor incentives and care coordination, and if it works, you're beginning to shoulder in on the territory previously held by Democrats. Thisll be worth watching.
The Republican ticket this year was notable for refusing to run on any policy innovations or substantive accomplishments whatsoever. In retrospect, most people think that a mistake. And so you're going to see a real effort in the GOP over the next few years to identify leaders who actually understand policy and can neutralize Democratic advantages on bread-and-butter issues. Chief among the prospects is Louisiana's Bobby Jindal, a former Rhodes Scholar and health policy bureaucrat who's taking a step into health care innovation today with a major proposal to reform how Louisian's Medicaid system works. 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. For a Republican, this is oddly similar to the payment system used by Britain's socialized National Health Service system, which uses fixed pay rates combined with pay-for-performance incentives. And along the same lines, Jindal's lieutenants are describing the plan in terms that could have come from, well, this blog:
