Last month, I made encouraging remarks to the Heartland Institute's outstanding monthly Health Care News about Rhode Island governor Carcieri's evolving proposal to reform Medicaid.

Well, the proposal is fully formed, and the state has just submitted its application for a waiver to the federal Centers for Medicare & Medicaid Services.  The New York Times does not like it, because it changes "much of its Medicaid program from an open-ended entitlement with no limit on spending to a capped budget with fixed expenditure limits."

Well, just because the NY Times criticises it doesn't automatically make it a good idea, but could you imagine even this bastion of the liberal establishment using that kind of language about any other government program? Imagine anxiety over:

• changing welfare from an open-ended entitlement with no limit on spending to a capped budget with fixed expenditure limits;
• changing the military from an open-ended entitlement with no limit on spending to a capped budget with fixed expenditure limits; or
• changing education from an open-ended entitlement with no limit on spending to a capped budge with fixed expenditure limits?

In fact, that's sort of what we expect from government programs, isn't it? That they at least pretend to adhere to a budget?

Governor Carcieri is a successful, retired businessman who decided to run for chief executive of his home state - his first real political office.  His Medicaid waiver is bold and realistic.  I'm sure that there's a devil in the details, but the key element is outstanding: accepting a hard cap on federal transfer payments for five years in return for state sovereignty over its Medicaid program.

It's a good start - but only a start.  Rhode Island ranks a lowly 48th out of 50 in the U.S. Index of Health Ownership - and it's not because of Medicaid, but a bad tort environment and over-regulation of private health insurance.

If governor Carcieri shows the same initiative and energy in reforming these parts of health care as he has in Medicaid, then Rhode Island has a healthy future.