OK

Certainly not for health care. Republican proposals for dealing with deficits, made acute by their hostage-taking leading to the panic-striking fiscal curb, often involve slashing Medicaid.  Many conservative red states have very limited Medicaid programs already; they seem to want to bring the rest of the country down to Mississippi's pathetic level.  This is supposed to save money.

But there's a fallacy in reducing Medicaid.  The growth of medical costs has had a huge impact on the overall economy, sucking the life out of the private and public sector alike.  Medicaid is only a small part of it, providing benefits to the elderly in nursing homes as well as to lower-income people, some of them working at jobs that don't include medical benefits.  Medicaid was begun in 1965.  It might be easy for a conservative nostalgic for a time when more people "knew their place" to imagine that if Medicaid were rolled back, then people could fall back on whatever they did before Medicaid existed.  But that was a different world.  It can't work.

A key fact is that the total cost of medical care in 1965 just wasn't all that high.  The Centers for Medicare and Medicaid Services (cms.gov) report that in 1960, national health expenditures were 5.2% of the GDP, rising to 7.2% in 1970.  That was the decade when Medicare and Medicaid made service more available to the elderly and poor. The current number is around 18%.  This subsequent increase has many causes.  The nation is older.  Treatment is better -- many cancers and other conditions that were fatal in 1965 are now usually treatable.  That much is good.

But much is bad.  The insurance system eats far too much of total expenditures.  Over-treatmentis very common, especially since the fee-for-service system makes it profitable.  Proprietary medical groups give doctors incentives to over-admit to hospitals (often at pain of firing).  End-of-life care is carried to extremis.  And prescription drug prices are just plain out of control, with almost no limit on greed.  A new cancer drug is sometimes priced at $1000/day, just because they can.

So what was it like in 1964, before Medicaid?  Did the poor get any treatment?  Yes.  There were charity hospitals that provided free care.  City hospitals treated the poor without charge.  In Boston, for instance, James Michael Curley, legendary long-term mayor in the early T.C., staked much of his political capital on City Hospital.  Most major cities had one or more public hospitals.  Not always great, but at least something.  Free clinics were common, and doctors often provided some pro bono services.

But now that insurance is the norm, with Medicaid covering many of the poor (though around 1/6 of Americans are still without coverage), the charity hospitals are gone.  Many now survive on their Medicare and Medicaid reimbursements, plus private insurance from patients who have it, and hard-pressed municipal governments no longer pay for them.  So if Medicaid went away, the "safety net" hospitals and clinics would lose so much of their funding that they could not carry on.

I suspect that many of the peasantry who vote for Republicans because of social issues simply don't realize that there is no medical care waiting for them should they need it.  The religious right is tightly tied to the faith-healing quacks who pollute the airwaves and scam their rubes from the pulpits.  That is the remaining "safety net" medical system in the absence of publicly-funded insurance.  We aren't going to have charity hospitals make a comeback; your medical "treatment" and funeral will have the same provider.  Often in short order.

That's the Banana Republic scenario we have to fight.

EMAIL TO A FRIEND X
Your Email has been sent.