It's Well Past Time for Medicaid Reform

Many approaches could be taken to Medicaid reform, including replacing the patchwork of state Medicaid programs with a consistent level of benefits through a national program, transitioning it to a voucher system (although for any reasonable amount of coverage that would cost far more than the status quo), creating a plan to put Medicaid recipients onto a private plan when the insurance exchanges come into effect (with need-based subsidies of deductibles and copayments).... But what we have right now is a mess. The expansion of Medicaid that is supposed to occur under the healthcare reform bill may break its back - even if present levels of participation by care providers are maintained, in many parts of the country those levels are inadequate to serve the existing population of Medicaid recipients.

The demand that the healthcare reform bill be "revenue neutral" killed any chance that the bill would address the many woes of Medicaid. Nationalizing the program and funding it at adequate levels would require a significant infusion of federal cash. It may be possible to engage in a privatization of the system through the exchanges created by the current bill, but that would also likely be significantly more costly than the status quo. Also, no private insurer is going to want to touch the end of life costs that Medicaid picks up for many of the nation's long-term nursing home residents and elderly population.

If any Republicans are listening to David Frum, or if Frum himself is done wringing his hands, maybe they could share some ideas?