While working to end ObamaCare is a good goal, reformers need to come up with alternatives. Rep. Paul Ryan, a conservative Republican, and Alice Rivlin, a Democrat and former head of the Congressional Budget Office, have come up with an interesting alternative.

John Goodman, one of the leading lights of health care reform that shifts some of the power in health care from government and insurance company bureaucracies to patients, offers a qualified endorsement of the plan. Ryan and Rivlin’s plan does more to protect today’s seniors from medical bankruptcy than ObamaCare. Yet it also does more to reduce government spending on Medicare, largely by vouchering Medicare for people who aren’t yet seniors.

Their plan also–and this is where it becomes most interesting for state legislators and a state-focused organization such as the Minnesota Free Market Institute–calls for the federal government to turn Medicaid into a block-grant program. Both states and the U.S. government fund Medicaid. States do most of the administrative work, but they must follow rules set down by the U.S. government, a requirement that can stifle experimentation in the states.

As a stand-alone reform, Ryan-Rivlin isn’t enough. Read Goodman’s critique to understand why. But it’s a good basis for discussion about an issue that threatens the fiscal solvency of governments across the nation.