Give Gov. Joe Manchin (D-West Virginia) partial credit for his understanding of what health care reform needs, and doesn’t.

He’s against Medicaid expansion, saying “We have a hard time living within our parameters now,” and “If it’s one-size-fits-all, then we’ve created an incentive not to be productive, not to contribute to society.” He has also expressed some sympathy for getting a grip on medical malpractice lawsuits, which contribute to the costs of defensive medicine.

On the other hand, he’s in favor of requiring insurance companies from basing their fees on health history and risk, a position that will make insurance more expensive for young adults, further giving them a disincentive to have insurance. Manchin’s position, known by the technical term “community rating,” is a major factor behind high insurance premiums in the few states that have it.

Cross-posted from State House Call.

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