Scalpel has made it clear that he would prefer the federal government stay more or less out of the uninsured crisis, as he feels that, given adequate resources, local authorities can handle it better. (please correct if I misstate your thoughts, Scalpel.) Michael Negron over at TPMCafe has an interesting rundown on the various proposals which have been floated to address the situation. Here's one which ought to please the other irascible Texan:
Another approach, outlined by Henry Aaron and Stuart Butler, is the creation of a structured national program of state experimentation with approaches towards expanding insurance coverage. This program could be enacted through federal-state “covenants” that condition federal funds upon the adoption of congressionally-specific policy constraints and approaches aimed at a set of defined goals. The “policy toolbox” of presumptively approved insurance solutions would enable advocates of different approaches, typically divided by partisanship or ideology, to buy into the program in hopes of building a broader consensus in favor of their views. The toolbox may also have the virtue of expanding coverage while simultaneously shifting the political playing field to the states, as advocates lobby state governments to adopt one approach or another. This approach may require preemption of state benefit mandates by federal regulation to permit. Like the individual mandate, this approach could expand health insurance coverage across the country while leaving costs rooted in administrative overhead and quality and efficiency of care unattended.Personally, I am not a fan of the 'local experimentation' model. The reason is highlighted by the disagreement between Scalpel and myself: his community apparently has great resources set up for for indigent/uninsured, while those in my community are inadequate for the need. If local communities are allowed to tinker with the options, it's guaranteed that some communities will screw it up and those people will suffer, and I feel that health care is important enough that it shouldn't vary by the accident of where you happen to live. It is true that a locally varying solution would be better than a universal solution that sucks, and I am really afraid of some half-assed please-nobody compromise will come out of this whole debate. I also admit that I have not yet read the full text of the Aaron-Butler proposal and I am feeling a bit too hypoxic and dehydrated after Karate to give it careful thought just now.