Even if it isn’t necessarily politically easy to implement. But the political impediment is merely a lack of political courage in the same politicians who natter on about how expensive and abused is the system in question. I’m writing here about our nation’s Medicaid system.
Medicaid is broken, and Republicans in Washington and in state capitals have an opportunity to fix it. President Trump has pledged to protect the program, in part by cutting waste, fraud and abuse. The House budget target would reduce the growth of federal Medicaid payments over the next decade from $2 trillion to $1.2 trillion. That is a good start. Medicaid wastes enormous amounts of taxpayer money as states use it to reward politically powerful healthcare providers.
Instead of making this sort of namby-pamby tweaks around the edges, and masquerading putative reductions in growth as cuts, the simple enough solution is this.
Take the Medicaid-centered Federal transfers to each State in the current year as the baseline, and convert that amount to a block grant with no strings attached, other than the State must spend the block money on its Medicaid program. Then, each subsequent year transfer the Medicaid block grant, similarly without strings, reduced further each year by 10% of that baseline amount. In a short few years (I’ll leave the third grade arithmetic to the reader, rather than insult his intelligence), the block grants will reach $0.00, and the Federal government will, quite properly, be out of this aspect of the State’s business.
Notice that this solution also does not touch the heart of our nation’s Medicaid system, which is each State’s responsibility. On the contrary, it moves the system entirely into the States’ individual purviews, giving each State complete control over its own Medicaid program, free of Federal touching.