Medicaid

Senate Democrats United In Opposition to Fixing Medicaid

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On a per-beneficiary basis, Medicaid is cheaper than Medicare. But that doesn't mean it's not part of the spending problem: Since its inception in 1966, total spending on the program has continued to eat up a larger share of GDP. 

One obvious reform would be to turn the program into a system of federal block grants. Currently, Medicaid is a joint federal-state operation that matches every dollar that states spend with additional federal money. The exact amount of the match varies by state, but on average the federal government pays a little more than half of total. At the same time, that money allows the federal government to exert a lot of heavy-handed influence over the management of the state programs: Take Utah, for example, which had to wait eight months to get a response from the federal government about whether it was allowed to contact Medicaid recipients over email. The answer state officials finally got? No. The federal government's response was delivered via email.

The incentive, then, is for states to spend ever-larger amounts in order to extract as much money as possible from the federal government, but not to innovate or experiment.  

It's not obvious to Senate Democrats, however. As Politico reports, they've made it clear they aren't willing to sign on to the block-grant approach. In a letter to President Obama, Sen. Jay Rockefeller and 36 other Democrats warn that block grants would "undermine" the "federal commitment" to the program. (As far as I'm concerned, the federal government's essentially unlimited commitment is a big part part of the problem.) "We are unwilling to allow the federal government to walk away from Medicaid's 68 million beneficiaries, the providers that serve them and the urban and rural communities in which they live," the letter says. 

Under a block grant system, the federal government wouldn't be "walking away" or anything like it. Indeed, it would still pay out hundreds of billions of dollars each years. Instead, federal officials in Washington would be putting state Medicaid programs on defined budgets and allowing them to manage the programs as they see fit. 

ObamaCare, naturally, makes the Medicaid problem worse for states.  

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  1. Obviously elderly care will be more expensive and the participants stay in the plan till death. Medicaid sees patients jumping in and out at their convenience.

  2. I think a more obvious reform would be to repeal Medicaid at the federal level and let states decide on their own whether to implement. What’s the point of sending the money to DC if it’s just going to get skimmed and sent right back?

    1. (laughs up sleeve)

    2. That allows DC to put conditions on the return of the money, giving them power and control.
      If the states decided things for themselves then they would not be under the power and control of DC.
      Power and control is much more important than being effective.

      1. Cynicism at its best. Keep up the good work!

    3. Because some states (with influential legislators) will get more out than they pay in taxes. What a deal! (For the states that get back less, not so much.)

  3. Charts like this are (yet another reason) why nobody takes states’ rights seriously. State and local potentates have offloaded so many of their own swindles onto the federal govt that the effect is just what Hamilton said it would be when New York and/or Philly assumed the debts of the states: the states are wards of the White House.

    1. That’s the point, Tim.

  4. Obstetrician 1: Get the EEG, the BP monitor, and the AVV.
    Obstetrician 2: And get the machine that goes “PING!”
    Obstetrician 1: And get the most expensive machine in case the Administrator comes.

    ——————————————————————————–

    Patient: What do I do?
    Obstetrician: Nothing, dear, you’re not qualified.

    ——————————————————————————–

    [After the doctors quickly drop the baby into an incubator, the mother looks up.]
    Patient: Is it a boy or a girl?
    Obstetrician: Now, I think it’s a little early to start imposing roles on it, don’t you?

    ——————————————————————————–

    Hospital Administrator: Ah, I see you have the machine that goes “PING!” This is my favorite. You see, we lease this back from the company we sold it to; that way it comes under the monthly current budget and not the capital account. [The doctors and onlookers applaud.] Thank you, thank you. We try to do our best. Well, do carry on.

    http://en.wikiquote.org/wiki/The_Meaning_of_Life

    1. Just make sure they’re in the fetus-frightening room!

    2. the “ping” machine is obsolete as the hospital shoulda known. therefore give my client lotsa money!

  5. I honestly think that they are trying to force a crsis that they think will justify wholesale government takeover of virtually everything.

    Why they pretend they will survive the conflagration they demand is beyond me.

    1. feral dog – the commerce clause is not a conflagration.

    2. That’s exactly the plan; it’s called the “Cloward-Piven Strategy”.

      But I don’t think that they’re pretending, I think big government leftists honestly believe in their own superiority almost to the point of feeling omnipotent.

  6. Suderman, naturally, makes the alt-text problem worse for commenters.

  7. One obvious reform would be to turn the program into a system of federal block grants.

    And how, exactly, does this satisfy the fetish for centralization which utterly rules Washington?

    You’re not being serious, Peter.

    1. They should just count on the states to fairly and rationally experiment with the program, like they did with civil rights laws.

      1. Is it ever not 1963 in your world?

        1. Was it ever 1963 in yours?

          1. No, because I wasn’t born yet.

            But I’d like you to examine your logic:

            Even if we go broke, and this thing is a proven total failure, we must never change course and allow the states more leeway, because they did some bad things 50 years ago, so we must assume that they will immediately twist having health care block grants into some kind of new scheme to reintroduce segregation.

            Your paranoia is alarming. And that something, coming from a paranoid guy like me.

            1. I think it is a false dilemma to have to choose between block grants and it going broke. And, given your history I don’t think it is being paranoid to be concerned about what happens with unfettered state control.

              1. You need to explain, very clearly, how giving the states block grants for healthcare, which has absolutely nothing to do with civil rights, will somehow be turned into a means to deny civil rights by the vast racist southern conspiracy which you clearly believe lives just beneath the surface of society, only waiting for the opportunity to rise up and reestablish the Confederacy, and that is secretly supported by plurality numbers of us southerns (even those of us, like myself, in mixed-race marriages).

                1. It’s not that I thin it will lead to re-segregation, I just think that like segregation it will lead to bad results. There are a lot of states that I do not trust to meet what I consider to be minimal standards.

                  1. Lets examine this sentence.

                    There are a lot of states that I do not trust to meet what I consider to be minimal standards.

                    Now, what on earth makes you our qualified philosopher king? Why should Texas give a shit, give even one seconds thought, to what you trust or what you consider?

                    1. I’m sure you feel this way about states with strict gun control laws and active affirmative action policies too, right?

      2. What, like women’s suffrage or gay marriage, those kinds of civil rights laws?

  8. One obvious reform would be to turn the program into a system of federal block grants.

    The 1996 welfare reform act, turned welfare into a block grant program. That seemed to be an improvement.

  9. “that money allows the federal government to exert a lot of heavy-handed influence over the management of the state programs”

    You mean they place conditions on giving the states money?

    Teh Horror!

  10. Agree with the article, but just be aware that the pronounced vertical tail at the very end of the graph is because of falling GDP since 2008.
    (I.e., even if the budget had stayed the same, the % would have gone up.)

  11. You mean they place conditions on giving the states money?

    Condition Number One being, “Take it. Or else.”

    Your childlike faith in the Best and Brightest is sort of touching, in a sad and pathetic way.

    1. Sorry, I do prefer the best and brightest of DC to the best and brightest of Arkansas for example

      “allowing them to manage the programs as they see fit.”

      1. You fucking tard, Arkansas elects the people who make decisions, just like the other states do. Where the hell do you think senators and bureaucrats come from, clone vats? And what makes some Italian asshole from NJ any better or brighter than a redneck from Arkansas?

        So, in your infinite superiority to us poor, uneducated southerners, where should these Top Men be coming from? The totally successful California?

        1. Sorry, I think the national consensus on most matters is a better floor than where many states would sink to.

          1. So regardless of what the people in an individual state want, what really matters is having the consensus of the people of the other states forced upon them. Got it.

            Also, you did not answer my question about where you believe these people, who are so much smarter and more capable than anything Arkansas could possibly produce, are coming from.

            1. “So regardless of what the people in an individual state want, what really matters is having the consensus of the people of the other states forced upon them. Got it.”

              Haha, I’m sure you feel this way about the many many localities that have strong gun control laws or affirmative action policies.

              “where you believe these people, who are so much smarter and more capable than anything Arkansas could possibly produce, are coming from.”

              From outside of Arkansas.

              1. Then why not let the people of Arkansas decide how the people of Arkansas live, and you can show your contempt for them by not going there?

                Isn’t that a bit more fair than using the federal government to impose the will of people who do not live in Arkansas upon those who actually do?

                1. How did that work out with civil rights? Yeah, Arkansas didn’t impose anything on their black citizens, right?

                  1. There is a big difference between the federal government telling the states that they may not create laws mandating that businesses treat people differently because of the color of their skin, and the federal government taking tax dollars away from the citizens of the states and placing conditions upon how those dollars are spent once they are returned.

                    To compare the two is, well, retarded.

                    1. These programs are for the needy and vunerable and many states have a very poor track record in dealing with those groups, so sorry I don’t support letting them administer them how they see fit.

                    2. As I said, to compare the two is retarded.

                    3. They have this in common, I don’t trust many states in both areas!

                    4. Another Mange “heads I win, tails you lose” post. Federalism is A-OK…as long as everything turns out the way he wants.

                    5. “big difference between the federal government telling the states that they may not create laws mandating that businesses treat people differently because of the color of their skin,”

                      States rights, Great Except When it Isn’t!

                    6. Ah yes, the familiar bleat of the liberal.

                      States rights is code for racism!
                      Anyone who says states rights is racist!

                      Go wipe the drool off your face, retard.

                    7. States rights is not code for racism, often the two go explicitly hand in hand!

                      But more importantly it’s not just racism I fear with unfettered states, there is all kinds of immoral and stupid things they might do.

      2. It’s always amusing when those who preach equality show how superior they believe themselves to be over those who they deem to be inferior.

        Show me a progressive and I’ll show you a lying hypocrite.

        1. Seriously. I can’t even respond to his last response to me, it’s so nonsensical.

          “It’s important to keep the federal boot on the neck of the states. This is to ensure that everyone is equal.

          Everyone is equal, except people from Arkansas, who are all inbred retards. I am smarter than all of them so it is right that I should make their decisions for them.”

          1. Notice how he said “I’m sure you feel this way”.

            The word “feel”.

            He makes no sense because he doesn’t think.

          2. I see it more like the federal foot kicking the state boot off whoever the states are holding down this week. The national consensus is usually better than local prejudices.

            1. My goodness, but you have quite the case of arrogant elitism, don’t you??

              What, EXACTLY, is your evidence that “[t]he national consensus is usually better than local prejudices”???

              And how do you discern this “national consensus” (other than, obviously, discounting the views of the residents of Arkansas)???

              By the way, Mr. Holier-than-thou, have you ever BEEN to Arkansas? Have you ever actually broken bread with the benighted residents of Mississippi? Or Louisiana (other than possibly New Orleans)?? Or been to a barbecue in Texas (NOT including Houston or Austin)??

              Or are you just a typical, ignorant, arrogant Northeastern elitist prig???

              FWIW, a close friend and law school study partner, who is black, having lived most of his life in northern urban areas, spent considerable time in Boston/Cambridge, and, finally, lived and traveled throughout the South, finds MUCH more overt racism in Boston than ANYWHERE else in the US (according to him, by far the most racist US city he has been in), and finds most Southern cities to be the LEAST racist. But, then, he’s probably not as smart as you.

              God you are annoying in your faux-morally-superior ignorance and arrogance.

              1. “What, EXACTLY, is your evidence that “[t]he national consensus is usually better than local prejudices”???”

                History and currrent events?

                “And how do you discern this “national consensus””

                Federal laws, polls

                “a close friend and law school study partner, who is black”

                OMG, the black friend meme!

                “God you are annoying in your faux-morally-superior ignorance and arrogance.”

                Good lord I think you are actually going to cry!

        2. Wantint people to be politically or even treated equally doesn’t infer thinking no one is beneath you. Besides it’s not that I think many State populations are full of intellectually inferior folks as much as morally inferior.

          But I love it when the conservative goes “No, no liberal, you must behave as my caricature does! What’s wrong with you!”

          1. Equality means everyone who disagrees with you is inferior.

            Got it.

            1. Sorry, it is not contradictory for someone for equality to dislike those who are not for it.

              1. Equality means not treating people as equals if you don’t like them, but they must treat you as an equal, especially if they don’t like you.

                Got it.

                No hypocrisy there.

                None at all.

                Move along.

                1. I’m not sure what you don’t get about this: as someone who values equality I think ill of those who do not.

                  1. Oh no, I get it.

                    Equality means that people who you like are your equals, and people who you don’t like are not your equals.
                    You treat your equals with equality, and the others with scorn.

                    Equality means that some are equal and others are not.

                    I get it.

                  2. But that’s the problem…you don’t just think ill of them, you believe that you should be allowed to make decisions in their place, because they do not meet your personal moral criteria. That is not treating them equally.

                    You can think poorly of someone as much as you like. But you take it a step further, and wish to limit their personal choices in order to enforce your personal policy preferences. Therefore, you are not treating them equally. Thus you do not actually believe in equality. You believe you are superior (belief is perfectly fine), but then translate that belief into forced action (not fine).

                    I understand nuance isn’t your strong suit (hence your constant conflating of any state issue with civil rights), but even you should be able to grasp the distinction between thought and action.

                    1. “Therefore, you are not treating them equally. Thus you do not actually believe in equality.”

                      Jim, Jim, Jim.

                      Equality to a liberal is a one way street. They expect to be treated as an equal, but they have no obligation to treat others as equals if they don’t like them.

                      You are talking about a two way street where liberals treat others as equals, even if they don’t like them.

                      Your problem is that you are thinking.

                      Shut off the mind and go on emotion alone.
                      Ignore your mind and trust your feelings.

                      Then you will understand.

                    2. Ignore your mind and trust your feelings.

                      So liberals are jedi in training? Shit, I’d better make nice with them!

                    3. What a bunch of silly mumbling, the only people I’m talking about are those who don’t value equality. As someone who values it I of course don’t care much for them.

                    4. Better to say I don’t want to let them treat their local minorities unequally.

  12. like they did with civil rights laws.

    ALL ROADS LEAD TO GODWIN RACISM SOMALIAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA!!

    1. For liberals every day is Selma 1964, for conservatives and libertarians no day was ever Selma 1964.

      1. Because not paying for peoples’ healthcare is just like turning the fire hoses on them. Or something.

  13. Sorry, I do prefer the best and brightest of DC to the best and brightest of Arkansas for example

    Well of course no one was talking about letting those tractor-pulling intern-humpers to hold any power.

  14. They should just count on the states to fairly and rationally experiment with the program, like they did with civil rights laws.

    Because you can’t trust government, right?

    Oh, wait, you’re saying we should trust the government.

    No, you’re saying we can’t . . . .

    Oh, I give up.

    1. I’m saying I trust the federal government more than many state governments.

      1. What’s so hilarious about this is that the worst state governments are the ones that are controlled by guys like you: California, Illinois, New York, etc.

        1. You mean the most productive states?

      2. The same federal government that enacted the Fugitive Slave Act, Mange?

        1. The Tuskegee syphilis experiment was also conducted by that noble federal government you seem to have so much faith in.

        2. Yes, the same one, and the one that eventually forced freedom on many of the states I now hold suspect.

          1. This same one?

            http://www.csmonitor.com/Comme…..se-to-kill

            How much evidence should the US government be obliged to show before it kills an American citizen?
            None, according to the Obama administration.

            And how much evidence should the government be obliged to possess of an American’s wrongdoing before officially targeting them for killing?

            That’s a secret, according to the Obama team.

            As part of its war against violent extremism, the Obama administration now claims a right to kill Americans without a trial, without notice, and without any chance for targets to legally object.

            Oh, yeah, I’m just brimming with trust for this shit. Care to provide examples of state governments indulging in this, or perhaps MKULTRA or Operation Northwoods-style hilarity?

          2. Ooh, ooh, or a state government conscripting Americans (disproportionately nonwhite of course) to go fight in wars on the other side of the planet.

  15. I’m saying I trust the federal government more than many state governments.

    And what about the states that are being held back by the feds?

    What if the feds mess up? You would rather have the wrong decision forced on all 300 million people than on just 1 million?

    1. Forget it, guys. MNG has his religion (the superiority of federal programs, run by the “best and the brightest”), and NOTHING you can say, and no failure of federal programs, no matter how catastrophic, will phase him, or sway the depth of his religious belief.

      By the way, MNG, how did that whole “best and brightest” thing work out for JFK, anyway?????? Vietnam, anyone??? Smartest thing JFK ever did was cut taxes – and most of his “best and brightest” were against that.

      Why won’t liberals EVER learn from history????

      1. “Why won’t liberals EVER learn from history????”

        This coming from a State’s Rightist is lol funny.

  16. Hey, MNG, you know what else was happening in 1963? The military draft and the Vietnam War. What’s that, chopped liver?

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