Joe Conason’s article contains nothing that is new to those who follow Texas government. It focuses on the Accenture contract and the attempt to save money by privatizing the health care bureaucracy, a scheme that was the brainchild of Arlene Wohlgemuth in the Medicaid legislation of 2003. I thought from the beginning that this was doomed to fail, because bleeding-heart state employees actually care about the people they serve, while the people hired to work at the call centers did not. The lobby-driven experiment cost the state half a billion dollars and was a total fiasco. At the same time, dentists have been providing kids with braces they didn’t need and charging the cost to Medicaid. Neither of these stories is new. Oversight is almost unheard-of in state government, as is evidenced by the see-no-evil Republican leadership’s failure to probe the data breach at the Comptroller’s office. TxDOT got an embarrassing report from the state auditor, and senior management was canned, but the agency continues to get everything it wants from the Legislature. The days when tough questions were asked at budget hearings are long gone. As Ogden says, all his colleagues care about these days is politics. Medicaid is a program badly in need of reform. If something isn’t done, it will break all of the states–and sooner rather than later. Perry was right when he said, in the first debate, that the federal government must give the states more flexibility. Instead, we have an intransigent bureaucracy that won’t even allow states even to institute modest co-pays. But Perry’s solution–block grants to the states–is no panacea. Medicaid is an entitlement that needs to be reformed. Block grants are finite grants that the state determines how to use. The likelihood that hospitals and clinics in cities represented by powerful legislators will be first in line for the money is high. Block grants are first come, first served, and when the money runs out, sick people will die. And you know that Texas will spend as little as possible. It always does. Under Perry’s “solution,” Texans will be sicker than they are today. The whole claim of states’ rights is fatuous. The states have never done a better job of protecting the public than the feds have. Perry even makes the absurd claim in his book that the states have protected civil rights in the past. Yeah, tell that to blacks in the South, from the time of Reconstruction to today. Block grants are just a way to reduce spending, not a way to improve health care. That’s why Perry likes them.