It's been a robust week for "Bobby" Jindal, governor of Louisiana and severely-warped-at-the-sawmill hunk of presidential timber. First, he gave a big old speech about how the Republicans have to stop being "the stupid party," which, to paraphrase Robert Duvall in True Grit, is bold talk for a creationist yahoo. Now he's the guest star at Fred Hiatt's monkeyhouse with an op-ed in which he explains how the Medicaid program will be much better off under the gentle ministrations of people like Rick Scott, Rick Snyder, Scott Walker and, well, him.

The entire piece is so much the customary carnival of euphemisms for Die On The Sidewalk, Maman — eligibility, benefit design, cost-sharing, use of the private insurance market, financing and accountability — that you almost don't notice that, in toto, it's simply the same old appeal to block grant the program to the states so Republican governors can use the money to do things like "Bobby"'s doing in Louisiana, eliminating the state income tax and the state corporate tax while propelling the regressive sales tax all the way to Mars. But I was particularly charmed by this particular passage.

States should be allowed to design their programs to promote value and individual ownership in health-care decisions. This includes using consumer-directed products, flexible benefit design, and reasonable and enforceable cost-sharing requirements. States must be freed from decades-old rules that are no longer relevant to 21st-century health care. For example, just like those of us who have employer-sponsored coverage or Medicare, Medicaid recipients shouldn't have free access to hospital emergency rooms for routine care. When individuals have no skin in the game, they are less likely to consume care responsibly.

A good example of what "Bobby" is talking about here is his recent decision to make sure that dying poor people have some "skin in the game" as they gasp their last breaths in some unregulated nursing home, or in the back bedroom of a two-story ranch that's going to be sold next month at auction because the people who owned it allowed their dying granny to ruin their personal finances by consuming care irresponsibly.It took him exactly one day to walk that back, probably because being a unfeeling wretch doesn't poll well in Des Moines. He is a coward as well as a fake. By his works, should you know him.

Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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