(Cross-posted from Tapped so you folks can comment.)
This column by The Washington Post's Steve Pearlstein is just inescapably bizarre. It's one of those depressingly predictable missives on how the Democratic Party is missing a major opportunity by not grinding their boot heels into the foreheads of their constituents, an act which, according to the author, would be both virtuous and politically savvy. It's win-win, so long as you're not a low-income constituent. In this case, the question concerns heightened premiums, deductibles, and copays for Medicaid, which Democrats oppose and Pearlstein somehow thinks they'd get widespread props for supporting.
Rather than falling back into the political set-piece of defending thestatus quo and demonizing Republicans for another round heartlessbudget and tax cuts, Democrats might have used the opportunity tochange the terms of the debate. With the governors at their side, theycould have pushed Congress to take the next step in transformingMedicaid from an entitlement program for the poor into a means-testedhealth insurer of last resort for all Americans.
A means-tested program pretty much is an entitlement program; it's just got a different name. And God only knows why government should want to run an insurer of last resort. That's gonna be quite a fiscal dream: a mopping-up operation for Americans too sick and disabled for other insurers.
If Pearlstein wants the government to run a means-tested insuranceprogram, he should recommend exactly what the majority ofleft-of-center pundits, think-tankers, and politicans already advocate:expand FEHBP, the program that currently insures nine milliongovernment employees and uses community rating (which means everyone,no matter their health issues, gets charged the same premiums, sonobody is priced out), by opening it to small businesses andindividuals. Easy, right? But since Pearlstein wants to really shiftthe debate, let's take it further.
Kill Medicaid and means-test subsidized access to FEHBP. Oncethat's done, turn the program into a model for the nation, reorientingit towards a pay-for-performance (and particularly improvement)structure with varying compensation for varying groups, thus makingcurrently untouchable subgroups profitable for participating insurers.
