As members of Congress bicker over the future of the Medicaid program, one phrase in particular has become a lightning rod, rallying cry, and Rorschach test all in one. Some believe that the use of a “block grant” system in Medicaid means that individuals will be forcibly cut off from the program and left with little to no care. To small-government crusaders, “block-granting” evokes memories of successful, large-scale decentralizations of federal programs in the 1990s. Completely handing off healthcare delivery to the states would permit experiments with new approaches, but it can potentially leave the door open to mismanagement and underfunding.
Canada faced similar questions over the role of the federal government in its healthcare system in the late 1970s. And our northern neighbors opted for decentralization. While Canada faces no shortage of maladies with its healthcare system, their experiment in block-granting was a rousing success. Their approach, which made spending more efficient and improved outcomes, shows a promising alternative to the way our Medicaid program works today.
