THE QUESTION ISN'T WHETHER WE'RE GOING TO MAKE GOVERNMENT BIGGER, JUST HOW:

Picking on Mitch Daniels (Robert M. Goldberg, 3.10.11, American Spectator)

To establish HIP Daniels shifted authority to state government and made personal responsibility central. Cannon claims Daniels "made Medicaid more attractive: Under his plan, the government hands out coverage plus something a lot like cash." By this logic, the 1996 welfare reform bill and Daniels' recent proposal to extend Indiana's school voucher program to every family promote big government because they both "hand out coverage."

Similarly Cannon has to denigrate the design and impact of HIP to portray Daniels as Obama's healthcare doppelganger. Cannon is half right when claiming HIP spending was higher than expected. Most HIP participants are older and sicker than the rest of Indiana and have had less care to boot. Short-term per patient costs of care were higher, at first. But after three months the average amount spent on participants and the amount of services consumed steadily declines.

There's a reason for that: unlike Medicaid, HIP is not an entitlement but a way to get well. It pays for preventive care. It pays doctors more for treating the most vulnerable. And it rewards staying healthy. If participants use preventive services they can keep HIP contributions to their POWER accounts. Participants are getting healthier, using fewer services. and saving more in their POWER accounts.

HIP has 24,906 adults with dependent children and 20,514 other adults enrolled. It also has a waiting list of more than 40,000 childless adults. That's not increasing dependence, it's unmet need. The federal government bars Indiana from enrolling more people in HIP. Daniels asked for more control over Medicaid dollars to expand the program. Obama said no.

The citizens of modern democracy consider health care to be a right, so we're going to have universal care. There are a number of ways we can deliver it, but all of them involve our paying for the care of our poorest fellow citizens. A universal and mandatory program along the lines of Indiana's, which re-imports market forces into health care, is preferable to one where government picks and chooses, or actually delivers, services. But if we don't have one like the former it will be one like the latter.

MORE:
Real Health-Care Reform: We don’t need top-down, centralized health-care reform; we need governance reform. (Leo Linbeck III & Eric O’Keefe, 3/08/11, National Review)

In order to effect real change, the president should support the idea of states’ assuming the primary authority and responsibility for health care. In other words, he should support the Health Care Compact.

A growing number of states are uniting around the Health Care Compact, which would give states both the primary responsibility for health-care regulation and full control over federal taxes spent on health care within their borders.

The Health Care Compact is a governance reform, not a health-care-policy reform. It would change who decides health-care policy, not who or what is covered. The Health Care Compact is needed because no centrally planned, top-down reform can fix health care throughout the United States. Instead, each state should craft its health-care policies to fit its specific needs. Some states may choose a single-payer system, while others may opt for a health-savings-account system with subsidies for seniors and low-income residents. Under the Health Care Compact, each state decides which plan is best for its citizens.

Posted by Orrin Judd at March 10, 2011 6:35 AM