March 3, 2005

Memo to Bredesen: Don't Reform TennCare. Really

Tennessee Gov. Phil Bredesen's plan for reforming TennCare, Tennessee's "Medicaid-Plus" healthcare program for the poor, the elderly and the disabled, consists mainly of slashing the budget. That's the wrong approach to transforming Medicaid into a workable program, argues Newt Gingrich in a new article published by the American Enterprise Institute. Bredesen would be well advised to read it. Gingrich writes...

As the discussion about overhauling Medicaid becomes more urgent, there is a grave danger that it will be narrowly focused on money, trapping lawmakers in an unproductive power struggle between federal and state governments. In truth, America's Medicaid challenges reach well beyond finances and budgets. The system is fundamentally broken, ensnaring the most vulnerable in our society in a cycle of dependence and poverty while failing to realize the benefits of emerging technologies and new capabilities in health and long-term care. Medicaid is beyond reform and cannot be fixed with small cuts and waivers from the bureaucracy. It must be transformed with legislation to bring it into the 21st century.

Does Bredesen have the guts to go for it? That appears increasingly unlikely. Bredesen ran for office - and won - on the implied promise that his healthcare industry expertise would translate into a plan to reform and save TennCare. But Bredesen's healthcare expertise was in managed care - basically, an industry that focuses solely and narrowly on managing healthcare costs, not on managing healthcare itself.

I once believed Bredesen might actually be a transformative figure in the healthcare public policy arena, a leader who would actually offer a new approach. A lot of Tennesseans believed that, I think, and that's why he narrowly won the governor's race. But since he took office more than two years ago, Bredesen has shown no sign of being a truly innovative thinker when it comes to transforming how the state delivers healthcare for the communities served by TennCare.

Instead, he has shown all the instincts of a corporate CEO focused on the quarterly financial reports. Instead of offering a truly transformative plan focused on the long-term, Bredesen merely plans to cut the program's budget. It's a short term fix, narrowly focused on money. Meanwhile, TennCare's cost has continued its inexorable rise. And the innovation on healthcare public policy is coming not from Bredesen's brand of liberalism but from the Right, from people like Newt Gingrich and South Carolina Gov. Mark Sanford.