Governments at all levels are facing severe fiscal stress, and Medicaid is the largest and fastest growing publicly-funded health program in the United States. State and federal authorities have had little success in controlling Medicaid expenditures with conventional reforms, and changing it from an entitlement program to a block grant program is now under discussion. This Issue Paper explores how transforming Medicaid into a block grant program offers the promise of improving patient care and restraining the growth in program costs.

To our knowledge, the Oregon Health Plan is the first government health care program anywhere in the world that has drawn up a formal procedure for rationing. After comment from interested parties, this state health program for low-income people ranks treatment for various diseases and conditions, currently from 1 to 680, in order of priority. The health care dollars available determine which priorities are met. As program costs have grown, the list of covered procedures has become shorter.

This document offers an alternative to the recommendations approved by the Colorado Blue Ribbon Commission for Health Care Reform (the 208 Commission or Commission) at its meeting on November 19, 2007. Its authors are among the Commissioners who voted against that set of recommendations. On November 7, 2007, the Commission passed a rule requiring any commissioner who wished to submit a minority report to vote against the entire package of recommendations. Although the authors voted against the entire package, they do agree with some of the recommendations contained in the set.

Parents need to be advised that rigid, motorized pool covers are not a substitute for 4-sided fencing, because pool covers are not likely to be used appropriately and consistently.

Pediatricians should alert parents to the dangers that standing water presents to children. Parents need to be advised that they should learn CPR; and they should keep a telephone and equipment approved by the US Coast Guard (eg, life preservers, life jackets, shepherd’s crook) at poolside.