Yuval, shouldn’t moving to premium support be expected to reduce Medicare fraud, which OMB estimated could have been as much as $48 billion in 2010? You’d still have the problem of people falsely claiming benefits, but at least beneficiaries would have an incentive to make sure that the money was well spent. Medicaid block grants would probably reduce fraud and abuse too, if only by giving states a dollar in savings for every dollar of fraud prevented.