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These four policies - replicating the experimentation that led to welfare reform, creating a right-sized plan to deal with pre-existing conditions, doing away with prejudicial tax treatment for employer health insurance and setting up a thoughtful Medicaid block grant - are practical alternatives to a health care policy doomed to fail either in the courts or in the court of public opinion.

Jim Stergios is executive director and Joshua Archambault is director of health care policy at the Pioneer Institute, publisher of “The Great Experiment: the States, the Feds, and Your Health Care” (2012).