Earlier this summer a pediatrician friend of mine was asking about ideas for health care reform since Olympia Snowe was going to stop by her hospital and talk with the doctors there. Unfortunately Snowe cut her visit short, but this is what I came up with:
A simple and cheap proposal for improving American health:
In short, I'd like to see a federally-funded, state-by-state performance-based incentive program to improve public health. Specifically, the federal government sets aside a decent chunk of money and sets targets for curbing health problems: e.g., "Reduce the growth of childhood diabetes in your state by 50% by 2012" or "Reduce the growth of cardiovascular disease in your state by 40% by 2013." If state A meets the target, they get generous federal funds for doing so. If state B fails to meet the target, they don't. Ideally, this would generate a lot of creativity in actually solving the targeted problems (since real money for the state would be on the line), but states would also have incentive to copy what works.
This program might cost some money-- but we'd be paying for results: if it flopped and nobody hit these targets, well, it'd have cost nothing. On the other hand, if this program got results, even if we consider the money going to states to be 'wasted' the program would still be a net financial gain from perspective of decreased strain on our health systems. In other words, with a results-based incentive system, we have nothing to lose if it flops and plenty to gain if it works.
Now, I'm sure the devil would be in the details. We'd need to pick targets that are easy to representatively measure and hard to game. It also seems like we could have a yearly governors' conference revolving around this incentive program for states to share tips on what strategies are working and which aren't. Make this conference (and the incentive program in general) a big deal, and make it competitive-- make states proud of their successes and ashamed of their failures.
In general, it seems to me that this sort of grand state-by-state competition for funds could be extended to a lot of social problems. Since it incentivizes results instead of naive/bureaucratic thinking, it might encourage some smart, actionable analysis about the roots of various social problems. But that's something to explore another time. My point is, I think this would work really well for improving public health, and we should do it.
p.s. Anyone have a good way of getting this idea into the hands of some congressperson?