That was the subject line of an email I received this morning. The author is Scott Lilly, now a fellow at the Center for American Progress, and a long-time key staffer for former Rep. David Obey on the House Committee on Appropriations.
The text of the email was relatively short:
For the last couple of months I have been looking at the Medicaid program and what Ryan would do to it. Today we are posting a report on the proposal which I think you may find interesting. There is a great deal that most people don't know about Medicaid and one is that a very big share of the benefits go to protect middle class people and their families from financial disaster in the event of severe accidents, catastrophic illness of prolonged infirmity in old age. Another is that Medicaid has played a major role in the dramatic decline this country has achieved in preventing miscarriages, birth defects and infant mortality (about 75% since Medicaid was enacted). A statistic that you might expect to be important to those who have spent decades championing the rights of the unborn. We are currently witnessing an attempt to make significant changes in those benefits in backroom deals that may not be made public until hours before the Congress will vote on them.
I hope you will find the report useful
Scott then provides links for the report, the first of which takes you to an introduction from which I will quote below the fold. Or if you wish, you can simply go here for the introductory page at CAP, which also has links to download the report.
If you had followed the link above the fold, you would have gone to a page with the following text:
The Ryan Medicaid Plan
A Threat to Middle Class Security
And that is KEY - too many think that Medicaid is a welfare program for poor people, who unfortunately are too often demonized as lazy, or people sponging off the hard working rest of us. And given our financial difficulties, perhaps we cannot afford to subsidize them so generously. Allow me to offer Scott Lilly's response:
But in fact Medicaid is not really a poverty program. As this paper will demonstrate, two-thirds of Americans living below the federal poverty line are not Medicaid beneficiaries. But the overwhelming majority of families who make up what is generally considered the nation’s middle class will be at significantly greater risk of facing financial catastrophe at some point in their lives if these benefits are taken away.
We all know people—or at least know of people—who had their lives changed in a split second. Whether it is an auto accident, the birth of a severely disabled child, a stroke, or devastating news from the doctor’s office, a well-planned and orderly life can be turned upside down almost instantly with grave consequences for not only the immediate victim but friends and family as well.
The medical costs associated with such events can run into hundreds of thousands and even millions of dollars. Many of us are lucky enough to have insurance that will cover most if not all of those costs. But few of us can manage the extraordinary burden of the long-term care requirements that such tragedies often leave in their wake. Few of us could cover such costs if we were the victims and even fewer could make a substantial contribution to the cost of providing such care for a relative that can no longer be cared for at home or in a community setting.
Many elderly and disabled Medicaid beneficiaries once lived in middle class households, and while they make up only 25 percent of Medicaid’s enrollees they account for two-thirds of Medicaid spending. It is difficult to envision reductions in Medicaid spending of the magnitude that would be required under the Ryan formula without significant reductions in this portion of the program.
That is about as much as I feel comfortable offering from Scott's introduction. Even if you just read the introduction and do not go on to the report (which if you have any serious interest in the policy you really should download and read), you will get a sense of how important Medicaid is as an essential part of the safety net for all of us, especially as noted in the last of the foregoing quoted paragraphs for those who are elderly - especially given the threats to Social Security and Medicare that may be part of any deal to raise the debt limit.
If we can grasp the importance of all the programs in the Social Safety net, several things should be clear.
1. We cannot begin to whittle away at the edifice of the social safety net without real risk of collapsing protections for lots of people
2. Properly played, this is a powerful political issue which we should not give away. We know the Republicans were taking a beating on the Ryan plan because of the threats it represents to Medicare, from which most people expect to obtain benefits, and for many either already do or who have older relatives that benefit from this. Properly framed, Medicaid can be connected to that and opposed to the insistence upon not taxing the rich, the hedge fund managers, the corporations.
3. Financially, if we do not maintain support for medical care, ultimately we wind up with people coming to emergency rooms, which still costs all the rest of us big bucks.
4. This is a moral issue. Our society still does a piss poor job of ameliorating the effects of poverty. We have a higher degree of poverty, especially among children, of any major western industrial democracy. I see it in schools. I certainly encounter it each time I travel to Southwest Virginia to volunteer in free medical/dental clinics, as I will be doing again in 2 weeks.
For those who want to understand more, what Scott Lilly has presented will be something of great use. For those who engage in policy discussions, you will be more knowledgeable and thus better able to respond to the blather and spin being offered by our political opponents and those who seek to demagogue the issue for either personal financial or political gain.