Health Reform

Wise words on State vs. Federal Administration of Medicaid

Yuval Levin has an interesting article in The Nation on Obamacare and the Senate’s most recently proposed bill, the Better Care Reconciliation Ace.  There has been a lot of arguments on both sides of the aisle about Better Care especially in terms of the provisions to decrease Medicaid funding and devolve more power to the States.  Mr. Levin believes that this is generally a good idea, but his comments below suggest that more of us should be less certain in our beliefs and more open to the possibility the opposition–whether Democrat or Republican–actually has some valid points.

In its scope and structure, this redesigned waiver would be unlike anything else in American federalism — which also means we don’t know how it would work.  Those of us inclined to look favorably upon a bottom-up, experimental mindset in policy design will be inclined to think the best of the possibilities here. I am very much in the grip of this prejudice myself. Those inclined to think the state governments are filled with bumbling fools while Washington overflows with subtle expertise will think the worst of this idea. But these different expectations are all rooted in roughly equal ignorance, and the results will probably be mixed enough to leave us all feeling mostly confirmed in our presuppositions in time — just as the performance of Obamacare has.

Do read the full article.


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