Matt Yglesias

Jindalcare

I find it a bit amusing that the two Republican politicians I invariably see described as “smart” — Eric Cantor and Bobby Jindal — both hail from major stereotypically smart ethnic groups. So I’ve been asking conservative friends and acquaintances if there’s actual evidence that Cantor is smart aside from the fact that he’s Jewish. They all assure me there is.

Jindal, though, is bringing the evidence the hard way by proposing a substantial reform to Medicaid that, if it works, could be a model for further things to come. Per Ezra Klein’s description:

The details remain a bit sketchy, but the basic idea seems to be that he’ll move Medicaid patients — and a fair number of the uninsured — into managed care plans that would receive a fixed rate per patient (the rate would vary with health status). That would eliminate the perverse incentives of fee-for-service care, presumably. But in order to ensure high quality outcomes, there would be financial incentives if physicians met certain performance criteria. Medical homes and more coordinated care would be a major part of the transition.

This is quite different from the current conservative vogue for slapdash efforts at “consumer-driven” health care and is aimed, instead, at delivering better health care to people by, to coin a phrase, experimenting with socialism. This is easier to do, ideologically, for a conservative because Medicaid is obviously already a government program so simply shifting its structure in a more socialistic direction doesn’t carry the stigma that creating a new socialistic program would. But if it can be implemented and it performs well, that could clearly lay the groundwork for future expansions of program eligibility, for structural reform to Medicare, for parallel reforms in other states, etc. It’s not a plan that offers the prospect of the sort of short-term system-wide reform that most health care advocates are looking for, but if a workable plan can be developed it has a ton of long-term promise and is compatible with the kind of things progressive reformers are trying to do at the federal level.

On the other hand, Igor Volsky observes that the somewhat vague description is also compatible with some pretty bad scenarios depending on how exactly this outline gets filled in.

Jindal Says No

Interestingly, it seems Bobby Jindal was being seriously considered for the Veepstakes but decided to say no in part because they feared that he might “be caught up in what they believed to be a less-than-stellar campaign that could pin a loss on Jindal without much ability to change or control the direction of the contest.”

Ross Douthat says this shows Jindal’s smarts. And perhaps so, though I actually have a hard time seeing a VP seriously taking the blame in a situation like that. It was never really my sense, for example, that John Edwards’ 2008 primary campaign was in any sense hampered by people blaming him for the loss of the Kerry-Edwards ticket.

Either way, I’m actually a bit skeptical of Jindal’s 2016 prospects. Discussion of this tends to begin and end with talking about whether the GOP is really ready for a non-white standard-bearer. I think a bigger issue may be that the next few years aren’t shaping up to be an especially promising time to be a governor. A governor presiding over an economic boom can cut taxes while increasing spending, and thus develop a reputation as a popular can-do pragmatist. Think of George W. Bush, George Voinovich, Christie Todd Whitman, and other classics of the 1990s. This also works if your state government is mostly financed by oil revenues and you’re in office amidst a commodities boom — Sarah Palin comes to mind. Louisiana does share some of Alaska’s petrostate attributes, but it’s not really the same situation, and right now he’s looking at the need to cut $1 billion in spending. Not his fault (though the decision to make up the budget shortfall with a mix of 100% service cuts and 0% tax cuts reflects the intellectually and morally bankrupt nature of contemporary conservatism) any more than the “free money for everyone” governors of the nineties were really geniuses, but it’s going to make it difficult for him to rack up the sort of Record Of Accomplishments that you’re usually looking for in a presidential candidate.