Matt Miller suggests Gov Jindal propose my book
January 30, 2013 3 Comments
Matt Miller (h/t @jp_mcginnis) has an op-ed suggesting that Gov. Bobby Jindal could revive the GOP politically and in policy terms by proposing a universal catastrophic coverage system for his state, altering the medical malpractice system and moving some of the Medicaid program into exchanges. Gov. Jindal opened this discussion with his suggestion of a large scale Medicaid waiver to implement health reform in Louisiana (Miller is nudging him further).
Roughly, Matt Miller is suggesting that the Governor do something like what I propose in my book, or what I claim to be the health reform plan that Democrats and Republicans would arrive at if they actually negotiated. The below is reproduced from my September 2011 post (I meant this deal as one that could take away the uncertainty of the looming Supreme Court Case, but I still see it is roughly what a deal would look like if the two sides negotiated from their key positions):
Central to the argument of my book Balancing the Budget is a Progressive Priority is the belief that what our country most needs to attain a long range sustainable budget is a political truce on health reform (ch. 7):
What our nation most needs is a bipartisan health reform strategy that will allow us to address the interconnected problems of the health care system: cost, coverage and quality. There is no perfect health care system and no perfect plan. However, without a deal that allows both political parties to claim some credit as well as to have some responsibility in seeking to slow health care cost inflation, we have very little chance of success.
It is well understood that health care costs are the primary long term driver of our fiscal imbalance (award for clarity of presentation), and so a viable health reform strategy is a necessary, but not a sufficient condition of ever having a balanced budget again. I lay out six next steps that I see as a bipartisan (everyone likely loves and hates something on this list) way forward to allow us to address the related issues of cost, coverage and quality.
- Replace the individual mandate with federally-guaranteed, universal catastrophic insurance coverage and sell private “gap” insurance in state-based exchanges
- End/modify the tax preference of employer paid health insurance
- End the Medicaid program by transitioning responsibility for dual eligible Medicaid costs to Medicare, while moving non-elderly low income persons into subsidized private gap insurance
- Enable Medicare to become an active health care purchaser
- Enact comprehensive medical malpractice reform
- Adopt an overall cap on federal health care spending backed up with a tax-based fail-safe
Note that you can get universality with catastrophic coverage either with a very high deductible and income based subsidy for private gap insurance, or you can have the deductible be based on income. True universal coverage is the holy grail of progressive public policy.