Several months ago on this list I mentioned that the current CMS was engaged in a strategy to increase the bureaucratic oversight in order to soften the ground for blockgranting (and no the irony of Republicans using bureaucracy by any means necessary to achieve policy goals does not escape me). CMS is correct in that state governments use money pulled down by Medicaid to fund other things (they may have a point as well to stop these abuses). Of course, it is the fiscal contraints of "tax cuts"/unfunded promise that have lashed states to the mast adrift in a sea of budget red ink that force states to use federal matching to leverage as much state money as they can.
CMS has gone further than questioning IGT's to question a whole host of enlightened state programs for poor kids, disabled, pregnant women, senior pharmacy, etc. in order to make some states cry "uncle" and say just give us the block grant and stop harassing us (and no the irony of Republicans subverting states rights and flexibility so by any means necessary they achieve policy goals does not escape me). The IGT issue is only the front of the wedge and a more "winnable" public argument (both because it is arcane and CMS is technically right).
However, Bush/Republicans most insidious contribution to health care is the Medical Savings Account and their increasingly varieted cousins. This is part of the general long run implementation of "Bud's Desire"** to make ordinary people pay,--the fracturing of social institutions (in this case social insurance) to create a "nasty and brutish" health care funding stream. That is, there has been a long run increase in the amount that people (disproportionately the poor and sick) pay directly for their own health conditions. The social benefits and shared risk of insurance has nearly disappeared.
Moreover, possibly the most insidious tendency of health care has nothing to do with Bush at all. It is the complete and utter lack of control/rationalization on both the scope and cost of medicine. There is no aspect of being human the current US free market will not try to "medicalize". There is no control over increasingly expensive procedures with increasingly small benefit (and sadly billions are spent actually misapplying health care and harming people). The problem becomes that payers (like the government) have no choice but to limit access and increase out -of -pocket costs and the weakest parties of our society (mostly the poorest) have to foot the bill.
Jim
**"Bud's Desire" is a phrase I coined for the nasty tendency of selfish/libertarian strains of politics to creep into policy. Named after Bud's (Harry Dean Stanton) comment in the movie *Repo Man* about "ordinary people": "If there was only some to find out how much they owe and make them pay."
"If Bush wants to dream big, why travel to Mars? . . . [W]hy not travel through time? We could go back in time to when all the continents were stuck together in one big-ass Pangea and just stick a flag in the middle and call it a day." --David Rees
-----Original Message----- From: John Lacny Subject: [lbo-talk] Bush prepares to destroy Medicaid This article is menacing. Bush wants to stop the states from using "inter-governmental transfers" to put up more money for Medicaid funding and thereby draw down a higher federal match. Basically, this is a preparatory move, because if he gets elected, his plan is to destroy Medicaid, probably starting next year, by turning it into a block grant program. (For those who don't know, that means that Medicaid will no longer be an entitlement, where eligible recipients are entitled to services; instead, the money will be given in a lump sum to the states so that individuals are no longer guaranteed services. Further, funding will probably be flatlined for years, regardless of social needs. This is what happened when AFDC became TANF.) -------------- next part -------------- A non-text attachment was scrubbed... Name: not available Type: application/ms-tnef Size: 6710 bytes Desc: not available URL: <../attachments/20040218/f9c8a538/attachment.bin>