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Momma said wonk you out

BOBBY JINDAL STEPS UP.

BobbyJindal.jpgThe Republican ticket this year was notable for refusing to run on any policy innovations or substantive accomplishments whatsoever. In retrospect, most people think that a mistake. And so you're going to see a real effort in the GOP over the next few years to identify leaders who actually understand policy and can neutralize Democratic advantages on bread-and-butter issues. Chief among the prospects is Louisiana's Bobby Jindal, a former Rhodes Scholar and health policy bureaucrat who's taking a step into health care innovation today with a major proposal to reform how Louisian's Medicaid system works.

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. For a Republican, this is oddly similar to the payment system used by Britain's socialized National Health Service system, which uses fixed pay rates combined with pay-for-performance incentives. And along the same lines, Jindal's lieutenants are describing the plan in terms that could have come from, well, this blog:

"We have a health-care system that doesn't behave like a system, " said Health and Hospitals Secretary Alan Levine, the main architect of the plan. He said the state needs a more coordinated system of care to improve on key health indicators such as the percentage of women on Medicaid who get breast-cancer screenings.
I'd add to this that Jindal does not seem to be going in the same direction as the rest of his party here. This plan focuses on improving the medical system, not making indviduals more acutely vulnerable to insurance costs. A week or so ago, Rich Lowry was in The Washington Post touting McCain's unpopular health care plan as one of the few conservative bright spots in the election. Jindal, to his credit, seems to sense that amping up the pressure of health costs is not really where the country's at, but that you can do a lot to cut costs by focusing on doctor incentives and care coordination, and if it works, you're beginning to shoulder in on the territory previously held by Democrats. Thisll be worth watching.



COMMENTS

He was on one of the talking head shows, and if he's at all successful in Louisiana (and given the low, low starting point, it's hard to see how he avoids it, even during a recession) he is someone the Democrats should fear--maybe not in 2012, but given that he's not even 40, for many years to come.

Sarah Palin will use this in the 2012 primaries to paint Jindal as a socialist who wants to take away America's best-in-the-world health care system and replace it with the socialized health care system they have in England.

The United Nations of Democracies was a policy innovation. It was stupid, but it was innovative.

This is Louisiana we're talking about. Watch the bar get set really low for health and mortality benchmarks that have to be met (or watch the necessary auditing just not be done), and you have an HMO's dream: customers who don't have anywhere to go if you provide them substandard care, or even no care at all.

OK, maybe it's too cynical to say that's what will definitely happen. But the pressures will be there, and they'll be strong.

Good for Jindal. Although one part of me is now too terrified of the prospect of GOP governance to want to see any GOP politician have his electability burnished by success, on the other hand they're bound to return to power some day, and I'd just as soon find out that they're no longer all a bunch of whack jobs when that day comes. Plus, if we're all honest with ourselves, we must admit it's not healthy over the long term to not have a credible opposition.

If the GOP reforms itself, it'll come from governors, who are usually forced to be more realistic and moderate. The devil's in the details, but it's surprising to see something from a Republican that isn't horrible on the surface.

NCProsecutor called it right. You can almost see the Washington Times headline now: Bobby Jindall--Socialist!"

The GOP leadership currently holding sway will never accept this sort of thing and they will happily throw Jindal and their election chances under the bus for the chance to reject "socialism".

I'm glad to see something happen on health care, and I wish Jindal luck with his plan. I don't think for a minute that his party will accept this sort of thing. His chances for higher office are nil.

I'm skeptical of it, because apart from Gustav, he was rushing to get this thing done before January 20. Also, the papers have reported that he's been taking meetings with Gingrich specifically on health care. This may be only phase one of something truly awful.

This guy let the legislature hoist themselves on their own petard over the pay raise issue and played them for fools just to get a voucher program passed. Let's not forget that.

socialism, schmocialism, the Republican knuckle-draggers who filled Sarah Palin's rallies will never vote for a non-white guy for President, ever.

teh Republicans created this monster, jammed the electrodes in its neck, and told it that Obama was bad, evil, un-american because he was...you know, DIFFERENT. wink wink, nudge nudge.

i hope Jindal doesn't get his hopes up.

Although one part of me is now too terrified of the prospect of GOP governance to want to see any GOP politician have his electability burnished by success...

Not to mention that HE'S NOT WHITE which seems to be the new bar set by liberals for electing politicians.

Capitated HMO care for MediCal (i.e. Medicaid in California) has been around for a decade. Here in Orange county it goes by the name "Caloptima". Not much of an innovation, apparently.

socialism, schmocialism, the Republican knuckle-draggers who filled Sarah Palin's rallies will never vote for a non-white guy for President, ever.

I don't know if this is quite true, but I do think it's safe to say this: there are a LOT of people right now who are voting Republican only on the basis of cultural-identity politics. So it's not so much that they'll take one look at Jindal and say, "I'm never voting for that guy." It's that they'll take a look at Jindal, take a look at Obama, see two guys who don't look like them, and be forced to vote based on something else. And people don't generally like Republican policies.

I can never decide how I feel when a Republican tries to solve problems in a non-crazy way. Am I happy that there any sane people on the other side? Or unhappy that it increases their chance of electoral victory? I tend toward the former.

El V, are you saying that 52.7% of the country is liberal? Since that's Obama's current vote percentage total.

You can almost see the Washington Times headline now: Bobby Jindall--Socialist!"

I never read the Washington Times. Do they really put exclamation marks in their headlines?

Of course not. If Louisiana repubs elected Jindal, he certainly can be elected by republicans in the north. He's the big hope of the party.

Not to mention that HE'S NOT WHITE which seems to be the new bar set by liberals for electing politicians.

I should think you'd get tired of saying such stupid stuff. Don't you get just a little tired of it? I'm pretty sure just about everyone else does.

Jindal is very late to the party. Texas, that bastion of socialism, implemented such a system years ago. Give one of the large hospital districts down here a call and see how they like it.

Louisiana is a special place when it comes to Medicaid. The state has two health care systems -- a private system for those that can pay and a bunch of state owned charity hospitals for Medicaid and the uninsured. And there isn't -- or wasn't -- much overlap between the two systems. I don't remember for sure, but I think the doctors are salaried at the charity hospitals. Which makes implementing the pay-for-performance a lot easier.

And as someone said upthread, Medicaid managed care is not a new idea; California started the trend a decade or more ago. It's the pay-for-performance component that's the real innovation.

Herschel: Funny.

We had a similar plan in Arizona, the last state to join Medicaid. AHCCCS (Arizona health care cost containment system) which worked fairly well when run by the state and counties. Then the crazy right-wing Republican legislature insisted on "competition." We now have dozens of private plans competing to dump expensive patients on other plans and constantly changing their rules. Naturally it doesn't save any money for the taxpayer and does not improve care over the previous government-run version.

socialism, schmocialism, the Republican knuckle-draggers who filled Sarah Palin's rallies will never vote for a non-white guy for President, ever.

That's just stupid. I loved Sarah Palin. If she runs for president, I will vote for her. I love Bobby Jindahl. If he runs, I will enthusiastically vote for him. Heck, I voted for McCain and I really didn't like him that much.

"That's just stupid. I loved Sarah Palin. If she runs for president, I will vote for her. I love Bobby Jindahl. If he runs, I will enthusiastically vote for him. Heck, I voted for McCain and I really didn't like him that much."

I didn't say every person who liked Sarah Palin is a racist that wouldn't vote for Jindal. obviously there are many who would, like yourself.

if i had said:
"socialism, schmocialism, Kevin S. Willis will never vote for a non-white guy for President, ever." than maybe you'd be right, and i would indeed be stupid.

but Palin ginned up a lot of ugliness out on the campaign trail, and i find it hard to believe at all those people yelling "ACORN!!!" at the top of their lungs are all of a sudden going to do a 180 and vote for a guy that looks like Jindal.

I thought the ACORN yellers had a problem w/stolen elections not racism.

Wisconsin took this step a few years ago and it's been a monumental disaster. It's called "Family Care" and its put our most vulnerable population and our taxpayers at the mercy of HMOs without ANY quality oversight or financial accountability. It was a going away gift from Tommy Thompson.

Doctors will hate this plan. And I'd imagine that it's already hard enough to attract and keep such skilled labor in Louisiana.

Anonymous: yeah, these are the same folks who said Obama was an Arab terrorist so it obviously couldn't be racism. Nice bunch of friends you have there.

The innovations are the Medical Home and Pay For Performance pieces. The problem is these are concepts that sound good. We believe these ideas should work, but we don't yet know that they work. There are several Pay For Performance tests underway but no consensus on optimal incentives. And the Medical Home idea is just getting traction. CMS is still organizing their test of the idea.

PSSST: Did you know that Bobby Jindl is of Indian (land of India) descent, that makes him caucasian, that makes him a membre of the 'white' race. Now, thanks to Obama being brown, any brown skinned person can be elected, so that means it must be for his/her ideas, not because of skin color. Or were we voting just on the 'skin deep' theory?

One data point doesn't equal a trend, EV.

many of you people's posts illustrate the fact liberals tend to project their own sick obsessions with race onto people who never even think about it.

Don't be fooled By Jindal's seemingly sane exterior. He's a nutbar social conservative from the farthest reaches of republican-right-wing cloud coo coo land. Here in New Orleans he's known as "The Exorcist," because he wrote his Rhodes Thesis on an exorcism he attended, and he makes it quite clear that casting out demons is an acceptable form of therapy for the mentally ill. His chief of staff is a submoronic homeschooled idiot who couldn't find his ass with both hands and any 'success' he's had in the governorship so far is entirely the result of the solid civil-service managership built up over many years by his democratic predecessor, Kathleen Blanco.

You're also missing the boat on the "non-white" issue here. In the south, East Indians are not viewed as "persons of color" but rather as exotic and quite possibly harmless and deferential 'foreigners.' The same mouthbreathers who rejected Obama in droves (outside of the city of New Orleans and a few other liberal bastions, whites in louisiana voted McCain by a margin of 9 to one) gladly voted for Jindal. He doesn't wear a turban (so he's not a 'hindoo'), makes a point of flaunting his christianity at every opportunity, and changed his name from Piyush to 'Bobby' because he was a childhood fan of the 'Bobby' character on the Brady Bunch. He's the most thoroughly assimilated 'colored' person you'll ever see, and in insisting that evolution is bunk he effectively reassures the Moron-Base that, despite his academic credentials, he's just as ignorant as they are.

He's definitely someone to watch in 2012.

Bobby Jindal doesn't believe in evolution, or that it should be taught in schools.

It's funny, but with the GOP they always have something disturbing just beneath the surface, and anti-science views are dangerous.

That mindset is one of the reasons why America has fallen behind in technology... and I hate to say it, intelligence in general.

No sane person should support someone like Jindal.

Bobby Jindal doesn't believe in evolution, or that it should be taught in schools.

It's funny, but with the GOP they always have something disturbing just beneath the surface, and anti-science views are dangerous.

That mindset is one of the reasons why America has fallen behind in technology... and I hate to say it, intelligence in general.

No sane person should support someone like Jindal.

John Doheny's right on the money. Although he had never hunted in his life, Jindal had himself photographed in hunting camouflage during the governor's campaign and used the pics in his campaign adds to burnish his right-wing, gun-nutty credentials.

I would add that Obama beat McCain in the whitest of the white precincts in New Orleans.

Jindal is first and foremost a Christianist. He's a creationist who believes in the power of exorcism. This is all that matters to the Christian base. His race is an added bonus because it can deflect the racism charges leveled at them from the Obama campaign while also not scaring off the racists in their own parties because, even in the most "white power" parts of the South, Indians are not seen as a threat. They are the smart, well-spoken immigrants that assimilate into the culture. Southerners don't fear crime, rape, drugs or gangs from them. Since he doesn't fit the stereotype of the big loud white southern Christianist type, he's their best hope for sneaking in a hardcore evangelical into the white house without anyone noticing.

If the left starts screaming out his exorcism and creationist beliefs the low information voters will just look at him and go, "Really? The Indian dude? No way he is one of those hardcore Jesus freaks."

Jindal is my governor, and he showed a remarkable ability to govern after the recent hurricanes. He was a real leader in a time when we needed one. I'm a democrat, but would gladly keep Jindal as our governor. He's atypical of the traditional Louisiana type of corrupt politician. This guy is good.

John Doheny, hilarious, thanks for the local commentary. I'd barely heard of Jindal before the last few days, for a moment it was frightening, a Republican who is not batshit crazy? Well you've help put that to rest. Thanks.

Somewhere in Jindal's schtick is an insurance company.

Managed Care plans like the well-known Aetna plans tend to suck. That we drag HMO's operating for profit into this becomes suspicious indeed...no service or lousy service all well managed of course.

This is a political trick to fool folks into thinking he's hot property for '12. I pity Louisiana; you are being used by an ambitious man for a stepping stone.

I think it's amusing that the subjet of Bobby's religionist whackiness wasn't brought up until way downthread with John Doheny's post.

There very minute element to Jindal's proposed plan that seem sane and palatable, on the surface. But realize that with this logical design comes a disgusting pro-life Catholic who helped Linda Blair overcome her demons.

What scares me? The dude is intelligent and relatively personable. He is a serious threat in the next 8 years. The Republicans will wet there pants that they have a spokesman who has about 3x the intelligence of their Wasilla Witch.

[quote]Bobby Jindal doesn't believe in evolution, or that it should be taught in schools.[/quote] Amusing how numinous not only misrepresents Jindal but has this quaint notion about "believing in" evolution. No doubt he complains about Palin's use of the English language as well.

But yes let's do dig down. Americans just elected a new President who spent 20 years in a cult-church run by a racist and an anti-semite who thinks Jesus was black and the CIA gave AIDs to black Americans. He even had this man as a key campaign advisor and no doubt would have given him a position in his administration if Hillary didn't go to bat for sanity. And there too is his [url=http://dogfightatbankstown.typepad.com/blog/2008/11/to-quote-weasel-zippers.html]his babysitter[/url], and his other friends.

In fact, yes lets please do dig a little - starting with the Obama, and then to every Democrat in Congress and how they have contributed to the financial mess which has had repurcussions around the world. Let's dig into the O transition team (don't you just love how 'change' for Barack means Clintonistas revividus and dredging the bottom of the Chicago River), let's dig a bit on the incoming appointees

Even we in Australia have heard of Jindal and recognise an intelligent and ethical, hardworking governor who has served and will serve his constituents well.

Pity we can't say the same about your President-elect but.

"who spent 20 years in a cult-church run by a racist and an anti-semite"

False.

"He even had this man as a key campaign advisor"

False.

"and no doubt would have given him a position in his administration if Hillary didn't go to bat for sanity."

False.

"And there too is his [url=http://dogfightatbankstown.typepad.com/blog/2008/11/to-quote-weasel-zippers.html]his babysitter[/url]"

Laughably false.

"and his other friends."

Which you somehow forgot to name.

"In fact, yes lets please do dig a little - starting with the Obama, and then to every Democrat in Congress"

Bring it on. You've got zip so far, after more than a year of digging.

"and how they have contributed to the financial mess which has had repurcussions around the world."

False.

"Let's dig into the O transition team"

Bring it on.

"(don't you just love how 'change' for Barack means Clintonistas revividus and dredging the bottom of the Chicago River)"

No, but I do love the smell of competence in the morning.

"let's dig a bit on the incoming appointees"

Bring it on.

"Even we in Australia have heard of Jindal and recognise an intelligent and ethical, hardworking governor who has served and will serve his constituents well."

ROFL... Translation: I have no idea who he is but he's Republican, so I need to praise him.

"Pity we can't say the same about your President-elect but."

Sure you can. It's easy. It even has the added bonus that it's true. Funny how that works.

seatech1,

I agree that Jindal did a good job dealing with Gustav and Ike, but neither of those storms devastated Louisiana like Katrina and Rita did (e.g., no failed federal levees), and Jindal had the full cooperation of the federal government, something the former (Democratic) governor did not have.

seatech1,

I agree that Jindal did a good job dealing with Gustav and Ike, but neither of those storms devastated Louisiana like Katrina and Rita did (e.g., no failed federal levees), and Jindal had the full cooperation of the federal government, something the former (Democratic) governor did not have.

Anon:

Bobby Jindal was elected by a Louisiana electorate, post-Katrina, that knew that the state Democratic Party was incompetent and corrupt.

Kathleen Babineaux Blanco decided to not run for reelection for a reason. Her 2003 campaign against Jindal was marked by racist, anti-Indian tracts peddled by Democratic campaign workers in the Cajun backcountry.

When Katrina exposed the Blanco Administration for the Deer-in-the-Headlights operation for what it was, most Louisianans ended up very sorry they didn't have Bobby Jindal as governor during Katrina. That's why they voted for Jindal-the Republican-after Katrina.

PaulB--Great way to unravel that skein of lies, point by point. So much more effective than ad hominem rhetoric. You showed how it's done!

Herschel--Ever since I began to consider EV's posts as a means of anticipating and prepping for the rhetoric of friends who have been hooked up to an intravenous drip of Faux News, it's been so much better. And I've been consistently prevailing over one such friend in our dinner debates.

"who spent 20 years in a cult-church run by a racist and an anti-semite"

False. ***true, very true***

"He even had this man as a key campaign advisor"

False. ***yes, he was his faith based adviser till he wasn't, so again true***

"and no doubt would have given him a position in his administration if Hillary didn't go to bat for sanity."

False. ***refer to the last truth**

"And there too is his [url=http://dogfightatbankstown.typepad.com/blog/2008/11/to-quote-weasel-zippers.html]his babysitter[/url]"

Laughably false.***not so laughable but may be true or not, fact is she is in hiding now, time will tell***

"and his other friends."

Which you somehow forgot to name. ***you mean, resko, plheger, farrakan,dailey and on and on***

"In fact, yes lets please do dig a little - starting with the Obama, and then to every Democrat in Congress"

Bring it on. You've got zip so far, after more than a year of digging. *** sorry, we got the kitchen sink and there is plenty more, did i mention ayers?***

"and how they have contributed to the financial mess which has had repurcussions around the world."

False.***now that is laughable, fannie and freddie were the biggest players and they were protected by dems, like dodd and blarney frank and yes Saint O!!***

"Let's dig into the O transition team"

Bring it on.**yes rham, he was on the board of fannie when they were cooking the books back in 2000, we can start with him***

"(don't you just love how 'change' for Barack means Clintonistas revividus and dredging the bottom of the Chicago River)"

No, but I do love the smell of competence in the morning.**yea, change is clinton back in the white house, i hope he brought some stain remover***

"let's dig a bit on the incoming appointees"

Bring it on.**we shall see, no doubt they will have ties to wright and phleger and farrakan and ayers***

"Even we in Australia have heard of Jindal and recognise an intelligent and ethical, hardworking governor who has served and will serve his constituents well."

ROFL... Translation: I have no idea who he is but he's Republican, so I need to praise him.

"Pity we can't say the same about your President-elect but."

Sure you can. It's easy. It even has the added bonus that it's true. Funny how that works.

Posted by: PaulB

"who spent 20 years in a cult-church run by a racist and an anti-semite"

False. "true, very true"

"He even had this man as a key campaign advisor"

False. "yes, he was his faith based adviser till he wasn't, so again true"

"and no doubt would have given him a position in his administration if Hillary didn't go to bat for sanity."

False. "refer to the last truth"

"And there too is his [url=http://dogfightatbankstown.typepad.com/blog/2008/11/to-quote-weasel-zippers.html]his babysitter[/url]"

Laughably false."not so laughable but may be true or not, fact is she is in hiding now, time will tell"

"and his other friends."

Which you somehow forgot to name. "you mean, resko, plheger, farrakan,dailey and on and on"

"In fact, yes lets please do dig a little - starting with the Obama, and then to every Democrat in Congress"

Bring it on. You've got zip so far, after more than a year of digging. " sorry, we got the kitchen sink and there is plenty more, did i mention ayers?"

"and how they have contributed to the financial mess which has had repurcussions around the world."

False."now that is laughable, fannie and freddie were the biggest players and they were protected by dems, like dodd and blarney frank and yes Saint O!!"

"Let's dig into the O transition team"

Bring it on."yes rham, he was on the board of fannie when they were cooking the books back in 2000, we can start with him"

"(don't you just love how 'change' for Barack means Clintonistas revividus and dredging the bottom of the Chicago River)"

No, but I do love the smell of competence in the morning."yea, change is clinton back in the white house, i hope he brought some stain remover"

"let's dig a bit on the incoming appointees"

Bring it on."we shall see, no doubt they will have ties to wright and phleger and farrakan and ayers"

"Even we in Australia have heard of Jindal and recognise an intelligent and ethical, hardworking governor who has served and will serve his constituents well."

ROFL... Translation: I have no idea who he is but he's Republican, so I need to praise him.

"Pity we can't say the same about your President-elect but."

Sure you can. It's easy. It even has the added bonus that it's true. Funny how that works.

Posted by: PaulB


Yea, Nicole, that was real good stuff rebutting it by saying it is false. I guess if Paul says it is false it must be even if it isn't. LOL, now that is laughable Nicole.


"""

PaulB--Great way to unravel that skein of lies, point by point. So much more effective than ad hominem rhetoric. You showed how it's done!

Herschel--Ever since I began to consider EV's posts as a means of anticipating and prepping for the rhetoric of friends who have been hooked up to an intravenous drip of Faux News, it's been so much better. And I've been consistently prevailing over one such friend in our dinner debates.


Posted by: Nicole

So was'nt the fact that Mitt Romney was Governor of Mass. when their "universal health care" plan was passed supposed to be his trump card that would put him over the top in the regressive party's primaries in spite of his "non -traditional" religious background? From my perspective, Jindal will suffer the same fate that the other Regressive party candidates will suffer in the next 10-20 years. He is doomed by his ideology. Aside from Jindal's aesthetics, the fundamental fact of his proposal is that his primary goal is to try to find a way to keep the "market" in the loop, not to find a way to make sure that everyone in his state has access to quality health-care that does not endanger any individual's financial health, or that of the state. This is the quandary that the regressives face. Now that their trump card of racial bigotry may be losing it's effectiveness, the fallacy of their core economic beliefs are starting to come into focus. And within that focus, an exposure of the verissimilitude that those beliefs are not meant to favor the middle and working classes, actually my belief is that they are purpose-fully anti middle and working class is what will come of people like Jindal.

So was'nt the fact that Mitt Romney was Governor of Mass. when their "universal health care" plan was passed supposed to be his trump card that would put him over the top in the regressive party's primaries in spite of his "non -traditional" religious background? From my perspective, Jindal will suffer the same fate that the other Regressive party candidates will suffer in the next 10-20 years. He is doomed by his ideology. Aside from Jindal's aesthetics, the fundamental fact of his proposal is that his primary goal is to try to find a way to keep the "market" in the loop, not to find a way to make sure that everyone in his state has access to quality health-care that does not endanger any individual's financial health, or that of the state. This is the quandary that the regressives face. Now that their trump card of racial bigotry may be losing it's effectiveness, the fallacy of their core economic beliefs are starting to come into focus. And within that focus, an exposure of the verissimilitude that those beliefs are not meant to favor the middle and working classes, actually my belief is that they are purpose-fully anti middle and working class is what will come of people like Jindal.

Ezra Klein is silly. There is no innovation here. Besides, the state government is in the habit of screwing the poor. This won't change anything.

Why all this love for Jindal here? I just don't get it.

Don't expect much from this plan. It is simply a way for the state to get out of the business of paying for health care for the poor.

I'm not worried about this Jindal character at all. I hope he runs for president in 2012 or whenever. I've heard he's 100% against abortion. No exceptions. Even in cases of rape, incest, or mother's life. Also he advocates teaching creationism in school. Republicans are seriously touting this guy everywhere??

When the poor have no charity hospital, they don't get treatment and spread thier infections to us. Jindal is gutting the LSU Charity system with this bill. The poorest people are the sickest as they don't eat the most nutritious food or take supplements. Studies show poverty increases stress and use of tobacco and illegal drugs are higher among the poor. I for one DON'T want to catch their diseases. I don't want to see them in MY doctor's office. I don't wont to be in the store where they sneeze on me. I want them to go to Charity and get a free shot and free antibiotics and not stay sick and spread thier germs.

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