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Over in the Wonk Room, Igor Volsky raises some possible concerns with Bobby Jindal's health care plan:
It could go one of two ways: the governor could either be introducing a truly effective ‘medical home model‘ — as is required by a 2007 state law — or a more industry-friendly approach that allows insurers to make short-term profits without focusing on long term investments (or value of care).Some have indicated that Jindal has chosen the latter. Louisiana Hospital Association president John Matessino, for instance, has described Jindal’s plan as “a very top-heavy, managed care’ assignment of patients” that would actually take money out of the Medicaid system to fund more insurance bureaucracy. The primary care physician would act as a gatekeeper, limiting care and keeping costs low, without coordinating patients’ care to ensure that each individual patient receives efficient, timely, and effective treatment. These plans have difficulty changing the behavior of physicians because they pay for episodic care and not value of care.It certainly could go that way. But I wouldn't really trust the president of the Louisiana Hospital Association to tell me whether it was in fact going that way. When you're talking about folks who make money from episodic care, you're generally talking about, well, hospitals. That said, the details on Jindal's proposal remain sketchy and skepticism is certainly warranted. Other states, like Tennessee, have tried similar reforms, and they've failed pretty decisively. Louisiana, however, has the good fortune of learning from those mistakes and having a governor who is legitimately steeped in the topic. They've also got some interesting additions in the medical home and pay-for-performance elements of the initiative. So it'll be interesting to watch. On a more national policy level, I think liberal wonks need to think about priorities here. It would be a good thing indeed if the American right developed a stance on health care that focused on improving care rather than increasing people's financial vulnerability to medical costs. Such an evolution would be much better for the goals of health reformers than would, say, a slightly more liberal Democratic caucus. It should be encouraged. And on a more crassly political level, you want to be careful to make sure that such a transition, if it happens, doesn't end up having a partisan sorting effect in which liberals spontaneously develop strong opinions against fairly sensible views on medical system reform. I take the mandate fight from the primaries as something of a cautionary tale here. In January of 2005, most liberals hadn't heard of health care mandates. By January of 2008, lots of liberals who supported Barack Obama had strong and fairly detailed positions against health care mandates, and lots of liberals who supported Hillary Clinton had strong and detailed positions in favor of health care mandates. I thought the latter group was right, but there was no doubt that if you'd reversed the positions of the two major candidates, you'd also have reversed the positions of their supporters. Even fairly educated political observers take their cues from favored politicians and opinion outlets, and so you have to be careful that in achieving one priority (blunting the political fortunes of a Republican comer, say) you're not doing collateral damage to another priority (medical system reform). Over at the Wonk Room, Volsky does a pretty good job balancing all this, and ends his post arguing that Jindal should emphasize the "medical homes" model, which I agree with. But as someone like Jindal rises, it's easy to imagine the incentives being weighted against the long-term policy goal and in favor of short-term political points, and that's something to be wary of.
