Gavra thinks that instead of the government rationing to only some this years technology, thereby leaving others with nothing (Medicaid), it could provide to everyone last years technology at a lower overall cost.
If someone wants this years technology, they can pay for it, instead of having the government provide it for them if they are poor, not getting it if you are middle class, and paying for it if you are rich.
(Why am I refering to myself in third person?)