My, my. The word of the day must be “nationalization”. In his column at the Washington Post Robert Samuleson calls for nationalizing Medicaid. How do we ease the budget woes of the states?
We could nationalize Medicaid — the federal-state health insurance program for the poor. We could transfer all its costs to the federal government; in exchange, the federal government would end state aid for K-12 education and transportation. Though initially a dollar-for-dollar swap, the change would give states more control over their budgets.
Created by Congress in 1965, Medicaid is hijacking state politics. Although the federal government covers a majority of costs (typically, 57 percent), the rapid rise in the states’ share compels cuts in other programs or steeper taxes. In the past decade, Medicaid spending has increased at nearly twice the rate of states’ tax revenue, notes the Volcker-Ravitch report.
The pressures will only intensify as America ages. Although Medicaid serves primarily a younger population (half are children), two-thirds of its costs stem from the 25 percent of much sicker beneficiaries who are elderly and disabled, reports the Kaiser Family Foundation. An older America will raise these costs and squeeze states’ other services.
I have severely mixed feelings about this proposal. As you undoubtedly remember I have written incessantly on the burden that Medicaid is placing on state governments’ budgets. And I sincerely believe that the federal government is proximally responsible for the mess in healthcare, at the very least on a “you broke it, you bought it” sort of basis. On the other hand I also think that the federal government is very poorly positioned to administer the Medicaid program and that the problems with our healthcare system can’t be fixed in the context of the fee-for-service system that the federal government appears to be determined to maintain.
You might want to take a look at this handy summary of Medicaid facts and figures. For example, the state with the largest absolute number and percentage of Medicaid enrollees is California with nearly one in three Californians enrolled in Medicaid. Between its public employee benefits problems and its high Medicaid bills is it any wonder that the state has budget problems? Medicaid is a big chunk of Illinois’s problems, too, which now impeached Gov. Rod Blagojevich aggravated by expanding Medicaid eligibility.
More than 30% of Medicaid bills nationwide are, essentially, paying for nursing homes. Long-term care of the elderly is an expensive proposition, too expensive for all but the most well off to be able to afford on their own.
We really do need to consider the question of the care of the elderly more seriously. To deal with the problem in a manner that’s both sensible and humane we’re going to need to change a lot of societal attitudes which, of course, will not happen other than kicking and screaming and at the very last minute. Or later.