After that lengthy aside, back on topic. This is what provoked me:
That is not the only instance in which Mr Obama has left the fine print to others. The defence cuts would be determined by a “fundamental review” conducted by the top brass. Big savings from Medicaid, the health-care scheme for the poor that Mr Ryan wants to entrust to the states, will somehow be achieved in consultation with governors, but without the federal government ceding control. Most glaringly, Mr Obama provides neither the details of the tax reforms he has in mind, nor a mechanism for drawing them up.
Ok, fair enough on the defense cuts, but Americans are barely willing to listen to the generals when they recommend cuts to defense so they certainly won't listen to pols. The Medicaid issue is what jumps out at me, the way the Economist phrases it they seem far more skeptical of Obama's method than they do Ryan's. I'm going to have to get around to doing my series of posts on Medicaid reform here in New York, that will make the issues clearer. But looking at Medicaid, even just a fairly cursory glance, reveals that one of the big issues is cost shifting between levels of government. By law, Medicaid currently covers a number of emergency services and things like institutionalized care in nursing homes as a minimum floor for the very worst off. These things are of course very expensive, but the feds pick up the bill so the states don't get crushed under the expenses. This also means however that it is usually cheaper for the states to dump patients into these programs rather than pay for overall cheaper and more effective programs that they have a higher cost share for. If reform is left to the states, this isn't going to stop. I'll draw this out a bit more with some posts on New York Medicaid reform, while I think Cuomo was trying on the whole not to do this too much, it did happen in a few areas with the original proposals, though I haven't compared the proposals to the final program yet to see if these problematic changes were the ones that actually happened.
I realize that people like the idea of the states as laboratories of democracy, but I'm skeptical of the idea myself. The key thing with a lab is that they do experiments that can later be scaled up more efficiently. I see very little of this in the US in recent decades. While some programs are based on programs initially successful in the states, or in the case of the ACA I'd say not so much successful as simply politically doable, on the whole this scaling up seems to be rare. Rather, individual states make successful programs, a handful of states copy these programs, and then the rest studiously ignore it in favor of their entrenched interests. For the laboratory of democracy concept to work, there needs to be someone in charge of assessing results and then scaling up successful programs. Individual states experimenting with policy in the absence of oversight aren't labs, they're just primitive craft workers not operating at efficient scales.