Sam Rosenfeld has a fantastic, highly-comprehensive post on Republican efforts to gut Medicaid and turn it into a capped, "consumer-driven" program at exactly the moment when its expansion and full-funding are most needed. Read it. But remember too that liberals shouldn't be reflexively against certain forms of consumer-driven health care, particularly health reimbursement accounts (or donut hole accounts), where employers/government place X dollars in an account at the beginning of each year, folks spend that money on basic care, once it's exhausted they have a deductible to cover, and then catastrophic kicks in.
What Sam's going against is South Carolina's bastardized version, where the amount placed in the account is based on a Risk Assessment, which means each individual is theoretically given a first-dollar infusion in proportion to their health risks. Unfortunately, we have no effective way to calculate risks and, in any case, the amount of bureaucracy, lawsuits, and general craziness that would result from trying would destroy the system.
Instead, you can insert progressivity not through risk assessments but through incomes. Everyone gets X dollars in their account, but those making less than $15,000 have a negligible deductible, those making $15-20,000 have a higher one, $20-25,000 is even higher, and so forth. You can even use the deductible to incentivize various cost-saving measures, like quitting smoking and losing weight. South Carolina isn't exactly a blue state, but if the Dems in Congress have any power, this is the sort of compromise they should fight for. And Democrats generally, when fighting against badly-designed HSA's, should keep in mind that there are certain ways to design them that could result in a program even liberals would love.
