Let the Feds Fund Medicaid?

| Sat Jul. 11, 2009 9:19 AM PDT

If we need more stimulus, what form should it take?  Matt Yglesias comments:

In an ideal world at this point what I’d like to see is more aid to state and local governments. Probably this should just be done in a very crude way — some flat per capita disbursement that could be implemented very rapidly at the federal level and kick specific decisions to someone else. Some of the money would be wasted or used in bad ways, but it wouldn’t be congress or the executive branch doing the wasting, so it’d be someone else’s problem. That kind of thing would work quickly, would be highly stimulative, and would allow structural shifts in the private sector to proceed apace.

Well, one quick way to do this might be to stop dinking around with alterations to the Medicaid funding formula (as the first stimulus bill did) and simply turn Medicaid into a purely federal program funded entirely with federal dollars.  This would instantly save states something on the order of $100 billion or so.  Here in California, we'd save a little over $10 billion, which would be $10 billion less in demand-destroying budget cuts we'd have to make.  Eventually this might lead to Medicaid becoming more standardized throughout the country, rather than being a hodgepodge of 50 different plans, but that's probably OK.  I'm not sure Medicaid has really been a great poster child for states as laboratories of democracy anyway.  Maybe it's time to turn the entire program over to the feds so it's not constantly a procyclical drain on the economy and be done with it.

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Comments

That's not really stimulus

That's not really stimulus spending spending though, which is supposed to be a one-off expense that ends within a few years. Moving funding of Medicaid to the federal level would be a longterm structural addition to the federal budget, and would make the future deficit picture look even worse. Plus you'd have to figure out a way to fund it at somepoint, and given the difficulty Congress is already having finding the will to increase revenues, that'd be pretty difficult.

excellent

Helping the states seems, to me, clearly the best thing to do. Teachers in this school district are getting laid off -- it wouldn't take much to save those jobs.

Fine With Me

As a resident of Illinois with doctors in my family, I support Kevin's recommendation. Illinois is not a laboratory of democracy in any way, and they are not good at paying bills. Simplico is right about the long term consequences, but the long term consequences of keeping control of anything meaningful in the state legislatures of Illinois, California, Alaska, New Jersey, New York, South Carolina, Georgia, et al are much worse.

We've seen many state and

We've seen many state and local governments take the stimulus dollars and just add to their own bureaucracies. That's stimulus only if we think everyone should work for the government.

How about more help directly to the people and industries that need it.

And let's have some goddamn big ideas this time around. No more fucking potholes, how about a couple of Golden Gate Bridges, Hoover Dams, and Coit Towers?

Frankly, I don't understand

Frankly, I don't understand why Medicaid isn't simple part of Medicare, and why the new public plan can't be part of Medicare too. Fix the issues with Medicare (payment levels, Part D's donut hole & lack of negotiating power, CER, etc), make the subsidies on a sliding scale, and you've got a pretty nice system.

Yeah, yeah, Republicans would never allow it, but why we're bothering to create another public healthcare plan when we've got one that people like and works pretty well is beyond me.

We suck.

*****Frankly, I don't

*****Frankly, I don't understand why Medicaid isn't simple part of Medicare, and why the new public plan can't be part of Medicare too.*****

It's because Medicaid is designed for poor people, and everybody in America knows lazy poor people do not deserve access to quality safety net programs like Medicare. Sheesh!

This is an excellent idea. I

This is an excellent idea.

I am self-employed and had to give up my increasingly-expensive individual, "major risk pool" insurance some years ago.

Last year I was diagnosed with breast cancer. Through what in the circumstances can be considered good luck, California has a special Medicaid program for breast and cervical cancer. Otherwise I would not be covered at all, since Medicaid here is generally reserved for those who are either disabled or who have minor children, no matter how low your income is.

But since Medicaid is a joint federal and state program, I am very worried about Medicaid cuts being made because of California's budget crisis. I have just been notified that, after two surgeries, chemotherapy and radiation, my cancer may have come back.

This is a very stressful situation for me. If the Feds took over, I would not be so worried.

Medicaid should be available to all whose incomes fall below a certain level. Sick people should not fall through the cracks because they are not suffering from a particular, "favored" illness.

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