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Bobby Jindal Embraces the Democratic Plan for Health-Care Reform


Bobby Jindal is no stranger to health-care policy -- quite the opposite, in fact. Before resigning from his position as an assistant secretary of Health and Human Services under George W. Bush, virtually his entire governmental experience was in health-care policy. He'd led Louisiana's Department of Health and Hospitals, and gone from that to executive director of the National Bipartisan Commission on the Future of Medicare. The guy is a bona fide health wonk. Which makes it all the more striking that his 10 ideas for health-care reform are so strikingly banal.

The argument of Jindal's op-ed is that "Republicans can lead" on health-care reform, but first they need to offer up some actual ideas. To help them along, Jindal proposes 10 of them: "Voluntary purchasing pools," which are a weak form of health insurance exchanges. Portability, lawsuit reform, coverage of preexisting conditions, transparency and payment reform, electronic medical records, tax-free health savings accounts, reward healthy lifestyle choices, cover young adults and offer refundable tax credits to the poor.

Nine of these 10 are in the current process in some form or another. Portability is achieved through the prospect of national insurance plans and multi-state compacts. Coverage of preexisting conditions is a given. Obama is funding an array of lawsuit reform test projects. Transparency and payment reform are in all the bills, as are electronic medical records, rewards for healthy choices, policies that help cover young adults, and tax credits to help with insurance costs. The exchanges make the voluntary purchasing pools look silly and small. It's a bit hard to "lead" on health-care reform when your brand-new proposals are about to be passed by the other party.

Jindal's ideas are the lowest common denominator of health-care policy thinking: electronic medical records and transparency and tax credits and purchasing pools. They eschew traditionally Republican proposals that are more radical, and thus less popular. John McCain's proposal to replace the employer tax deduction with a tax credit represented a much more serious conservative approach to health-care reform -- an approach that, for better or worse, created a system based around individuals, rather than government subsidies to employers. But he lost on it, and so ambitious Republicans such as Jindal have abandoned the underlying thinking.

The problem, however, is that they haven't replaced it with anything, so they're left mimicking the least controversial elements of the Democratic agenda. At the beginning of his op-ed, Jindal laments that "a majority of so-called Republican strategists believe that health care is a Democratic issue." But the rest of his op-ed simply proves that they're right. If Jindal, who knows this stuff cold, isn't going to be the Republican who leads on developing a new conservative consensus, who will be?

Photo credit: By Bill O'Leary -- The Washington Post

By Ezra Klein  |  October 6, 2009; 12:02 PM ET
Categories:  Health Reform  
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Testify, brutha Ezra!

Hard-hitting as this take-down is, I have a feeling it could have been even harsher.

Posted by: Rick00 | October 6, 2009 12:12 PM | Report abuse

See also Aaron Carroll's slightly earlier post on this (if you're not reading him, you should):

Posted by: TheIncidentalEconomist | October 6, 2009 12:20 PM | Report abuse

"Nine of these 10 are in the current process in some form or another. "

I guess its a matter of degree- and your Obama-cheerleading tendecies are "rounding up" each proposal to full credit. An unibiased, non-partisan view would be different.

Portability is not addressed in these bills. Portability is primarily about people taking their insurance with them when switching jobs, and neither national insurance pools nor multi-state compacts address that. Wyden-Bennett did. McCain did. Obama didn't.

Malpractice pilot projects is different than actual reform. Obama's plan doesn't have a clear end game, which is a feature, not a bug. This is as accurate as saying that McCain's plan for pooling individuals for risk-sharing addressed the community rating issue. Um, no. For both.

Payment reform is in the plan? Yeah, for roughly less than 10% of actual health care expenditures. 10% gets rounded to... yup, we've got payment reform! Give me an A! Give me a C! Give me an O! What does that spell? ACO!! Yea, they now exist!!! Please.

HSAs? I'll admit to not knowing the granular specifics, but Jindal's point was that legislation needs to loosen existing restrictions, and I'm unaware that the current plans do so.

So that leaves 6 in my book, not 9. More importantly, its not like I said anything here that you don't know. Will the upcoming plan do something, no matter how incrementally small, on most of these? Sure. And maybe that's all that Obama could get given the amount of political capital he's spending on the public option instead. But pretending that the Obama plan meaningfully addresses the ones I mentioned above is partisan and inaccurate. At some point, it'd be nice to see you do a piece that put the policy first and politics second.

Saying that the emerging plan addresses portability is a violation of "wonkishness" that should get you a six month-suspension from the wonk world.

You know better than that.

Posted by: wisewon | October 6, 2009 12:27 PM | Report abuse

I think you're making a mistake taking this at face value. Jindal is positioning himself for the Republican nomination in 2012. He reads the tea leaves and sees that healthcare reform will pass and wants to attach himself to it. So he waits until a general consensus bill forms, summarizes it in an op-ed, and gets to claim it was his idea. Ther eis no political upside to it for him to offer new ideas right now, especially if the existing healthcare bill passes and becomes relatively popular.

Posted by: Quant | October 6, 2009 12:41 PM | Report abuse

Also, I think you mean "Greatest Common Factor" =)

Posted by: mariobonifacio | October 6, 2009 12:45 PM | Report abuse

wisewon, your comments keep this blog worth reading. Keep it up

Posted by: ab13 | October 6, 2009 1:03 PM | Report abuse

and if you're looking at the 2012 elections why would you want to hitch your name to reform. By that point the positive points of the reform (Medicare savings, exchanges, end to pre-ex) will barely be in place for some and not at all for others but the negative impacts (taxes, surcharges, escalating costs) will start almost immediately all at a time when the economy is still struggling mightily. To me an adept Republican politican will stay in it enough to say he was involved but far enough away to say "look its not working".

Maybe those looking to 2016 and 2020 would have an easier time of it but not 2012. How's the old saying go, "Its going to get worse before it gets better"

Posted by: visionbrkr | October 6, 2009 1:18 PM | Report abuse

""Nine of these 10 are in the current process in some form or another.""

A more clearly enumerated elucidation would be nice, at least to clarify the issues when people like Wisewon gripe at you - and to more clearly state whether you think the form they've taken in the current bill is as good as, inferior to, or superior to Jindal's formulation. "In some form or another" isn't the most transparent phrase, after all.

More obviously, for those of use who aren't following this as closely: What was the remaining, tenth issue that's not in the current process? Does it have any merit?

Posted by: WarrenTerra | October 6, 2009 1:34 PM | Report abuse

i think you could easily debate whether 9/10 of those items are included in the Dem plans, but the Jindal piece is still bunk as it puts forth general goals and concepts as if they are ideas...

portability is the best example. talking about portability as an idea, as if other folks don't want it, is dumb. how are you gonna achieve portability? eliminate the income tax exclusion? force employer plans to cover ex-employees?

seems like an exchange with national and/or regional plans would be a start, but portability depends on affordability, even i i could take my current plan with me to the next job, i would only do it if the next employer was going to start making the contributions my current one is now making...

repubs that talk about portability should be forced to say how they will get there - but those are the details that voters have rejected so they won't...

Posted by: tsweeney1 | October 6, 2009 1:43 PM | Report abuse

The Republicans can easily set a political trap. Moderation can be the face of it.

If the Democrats don't deliver a universally accessible non-profit public option -- at least for the bronze (or basic) coverage -- they will lose control over the next elections.

Why? Because there is no way for the Democrats to mandate individuals' payments to private corporations without looking like idiots.

Good luck trying to explain that to the voters! In sound bites!

Not to mention topping it off with MORE taxpayers' money than necessary, to pay for the mandated private insurance for the poor.

"Why didn't you save us money while you had the chance?"

Never mind that the Republicans will be hypocritical. They will be laughing and hanging it around the Democrats' necks. Rightly so!

Posted by: Lee_A_Arnold | October 6, 2009 1:54 PM | Report abuse

I have two "Republican" ideas, which many Democrats would be willing to support.

1) Pay states to remove the regulations which fracture the healthcare market. Any state which scraps its own healthcare regulations and accepts a national (or interstate) plan instead will receive subsidies for its underinsured.

2) Have the Federal Government fund specialized Malpractice Courts in any state that wants to experiment with them.

Posted by: differentspeeds | October 6, 2009 2:18 PM | Report abuse

Rereading my post, its a little snarkier/meaner than I'd like-- but still accurate. That said, I think WarrenTerra is getting at the larger point.

Ezra-- you've got a responsibility, as a blogger in the news division, not opinion section, to provide the facts as is. I get that a perfect wonk-type bill won't get through Congress. But for folks that are relying on your for information, its important to establish 1) what could/should be in the bill from a policy perspective, from 2) what can be in the bill from a political perspective.

Post such as this one both conflate the policy and politics in a way that is inaccurate to readers who don't share your base knowledge. Its based on a set of assumptions-- e.g. how much payment reform really is feasible in 2009-- that readers may not share, but is ultimate core to your post here. You believe that, more or less, Obama is getting as much as he can on the issue Jindal has raised. I don't. That's a political judgment/strategy question where we differ. But on the policy front, there's no question that the upcoming plan does not nearly address the points Jindal raised as it should. That distinction should be a lot clearer from a news division blogger.

Posted by: wisewon | October 6, 2009 2:19 PM | Report abuse

Dictionary according to Ezra:

Leadership: advocating for the most possible government involvement in the subject matter at hand (or at least more than anyone else).

Posted by: WEW72 | October 6, 2009 2:47 PM | Report abuse


It's right to debate the extent to which the current reform package meets that list of goals, but remember that what Jindal put out was just that: a list of goals, with absolutely no mention of process. It's hard to determine whether the current package is getting enough on say, portability, when there's no alternative given to compare to. What Jindal proposed was trying to address 10 issues, without proposing any way to do that. What Ezra's saying is that the current proposals address those issues in some real way, without comment on whether they do so in a small way or a large one. I think all of the writings of this blog have been pretty uniform in the overall view that the current reform bills fall way short of the wonkish ideal. The point where this becomes a debate over how far reform goes to accomplish those goals is the point where specific alternatives arise as a point of comparison.

Posted by: etdean1 | October 6, 2009 3:41 PM | Report abuse


exactly why should Jindal put anything about the process out? he's not anywhere near involved in the process as the Govenor of Louisiana. He could speak to his own state and how they operate in this regard and how it compares to the reform efforts but its useless for him to speak on the reform efforts other than to say "Not all Republicans are seemingly against reform". To that end he's taking a politicial gamble towards an eventual 2012 Presidential run I suppose similar to what Romney and Huckabee have done.

Posted by: visionbrkr | October 6, 2009 3:52 PM | Report abuse


I agree that this is actually a strong political calculation on his part, to just say "I'm bipartisan and want to fix healthcare too!" without having any costs attached. From the standpoint of writing a worthwhile op-ed, however, it's necessary for him to say "here are some facets of successful health care reform" without proposing any way to achieve them. We've already heard that portability, defensive medicine, etc. are important considerations, he's not unearthing new ground there. My problem is that I think it's intellectually dishonest to say "we should scrap this bill to work on a new one to address these 10 points" when nine of those are already addressed in this reform package. For him to help the debate would be to say, "here's why the current proposals don't address (insert point here) well enough, and here's how to do it better." Right now, he's just providing white noise.

Posted by: etdean1 | October 6, 2009 4:30 PM | Report abuse

Sorry, screwed up a line there, should read "while proposing" and not "without proposing"

Posted by: etdean1 | October 6, 2009 4:32 PM | Report abuse

For better or worse, the proposals in Congress (which I guess we can collectively consider Obama's plan) are real, detailed, working blueprints for a new health care insurance system. Jindal's op-ed is just that: an op-ed -- which is to say, not that much more than a blog post.

So complaining that a particular point made by Jindal is only 60% covered in Obama's plan is pretty disingenious, since we have no idea -- and no way of finding out -- how much coverage it would really get in Jindal's plan, because there is no Jindal plan.

That said, I agree that Ezra was being pretty disingenious himself about tort reform, since it's pretty obvious Team Obama is using it strictly for PR purposes.

Posted by: PeterPrinciple | October 7, 2009 4:32 PM | Report abuse

My comment (in verse) on Gov. Jindal's healthcare reform plan:

Gov. Jindal,
Your reform plan’s a swindle.
Still, I do appreciate
Your call for Republicans to participate.

(Read the rest at

Posted by: RayinDC | October 8, 2009 7:03 PM | Report abuse

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