(Portions cross-posted at
The Greater Rochester Weblog)
Since President Bush began beating his drum to reform Social Security, many progressive voices spoke up pointing out that Medicaid was the larger crisis and needed more immediate attention. Being from New York State, and feeling the oppressive taxes burdening communities to cover Medicaid costs, I hoped that a groundswell was building to address the problem.
The Democrats could pick up the mantle of reform at the local, state, and federal levels by focusing in on Medicaid reform. What happened? And is it too late?
I don't think so.
In my new
blog, I go into some of the funding problems we're facing in New York State when it comes to Medicaid.
Currently, New York has the dubious distinction of having the highest per capita Medicaid costs (that means per person) of any state in the Union, more than doubling the national average. The Empire State also comes in first for overall Medicaid spending, beating out California by close to $10 billion dollars, with a grand total of $40.6 billion. State spending for Medicaid (separate from Federal and local spending) accounted for 25% of the New York State spending in 2003. I live in Monroe County, and we spent $831 million for Medicaid expenditures in 2003. This is more than the total spending of 8 other states!
Not only are costs high due to one of the more generous programs available, but also the methods of covering costs spread the political liability around between state, local, and federal levels.
The problem is compounded by the way the burden of costs are shouldered between the federal, state, and local governments. The Federal portion of Medicaid covers between 50% to 77% of the total bill, depending on the state in question. New York receives the lowest allowable percentage of 50%. The state also passes some of the costs onto the counties, one of 18 states that follow such a process. Again, our New York state leads the pack. Counties pay 18% of Medicaid costs, where in the next highest state, Iowa, counties pay only 11%. This "pass the buck" game also ends up saddling local governments with unfunded mandates over what care needs to be covered and what does not, regardless of the needs of the individual communities.
What strikes me here is that we have a program that is inefficient and damaging to the economy of the states, which stretches across all levels of Government. Why isn't this an issue for Democrats? What better way to establish health care credibility than taking on the inefficiencies in the current systems?
I am believing more and more that we cannot set up a single payer system without first establishing ourselves as a party that can be trusted with the responsibility of creating such a complex program. God, I hate to paraphrase the cliché, "But it's the credibility, stupid!" We cannot show up as Johnny-On-The-Spot with a massive federal program and say, "This will solve everything!" We need to make our bones with the American people by making what is already in front of them cheaper and more effective. When they realize we can be trusted, then passing Single-Payer will be a breeze.
Now the beauty of Medicaid Reform is that in many states, you can run on it at multiple levels of government. In the 18 states that split costs with the localities, running on reform can get us seats. In all 50 states, we can be running for State seats by addressing this issue and keeping the program focused on where it should be. At the federal level, we can say over and over again, that this is a real problem today that is felt on Main Street, USA. Action must be taken to help the states that are feeling the cost burden by bringing their programs more in line with the rest of the states.
The real worry we should have is that Republicans take on this issue before we do. We all know what kind of things they'd do to the program if they got a hold of it. I also believe there will be a fair amount of "Political Capital" gained by whichever party that has the balls to take this on.
Medicaid is a very real problem facing ordinary Americans every day. It deals with policy issues that our party can rally around, and it also incorporates values issues of taking care of those that most need it. Medicaid reform is a challenging issue, but one that the Democrats are uniquely suited to deal with. All it requires is determination and resolve to take strong principled stands.
I believe we are still made of that kind of stuff.