I keep reading stories like this...
WASHINGTON - The Bush administration believes it can improve services for Medicaid beneficiaries and help the program's shaky bottom line by caring for more elderly and disabled patients in their homes or through community-based programs. [Note the lack of the use of the term, "faith based" - Ed.]
...President Bush's 2006 budget proposal seeks $500 million over five years to move some of the disabled out of institutions and into these community programs. For patients who make the switch, the federal government would pay the entire cost of care in the first year and then split the cost with states - anywhere from 50 to 70 percent - in subsequent years...
...and I continue to think that BushCo's real end game is to phase out a true problem child for both state and federal governments - Medicare and Medicaid. Just as a refresher, Medicare provides assistance to (primarily) the disabled and elderly after they've exhausted their own personal assets, and Medicaid provides assistance (primarily) to the poor who had no assets to begin with.
$100 million per year -- I had to chuckle when that number sunk into my non-financially oriented mind. First off, a half billion dollars over five years is a drop in the Medicare sea of red ink, and will do little more than cover the salaries of the bureaucrats who will need to be hired to justify cutting off Medicare payments to the affected constituency. The burden for covering the cost of care for these patients will then shift either to the states, or to the families of the patients.
State governments are already busting their budgets in trying to keep Medicaid programs afloat. I've blogged before that Medicaid is, for obvious reasons, low-hanging political fruit and an easy target for either devastating cuts or total elimination. Medicare is only a branch or two higher on the fruit tree.
In reading the timeframe expressed in the above cited article (one year), I believe BushCo's going to move exceptionally quickly in gutting both programs, using a faux Social Security fight for cover. And why not? The political risk / benefit equation is tilted dramatically in their favor.
Listen, I can't get inside these people's heads to figure out what's really going on, but with every alarming story I read on Medicare / Medicaid, it makes more sense.
From a Medicare perspective, it's made more sense since the advent of Elder Care tax deductible accounts, and the relatively recent offering of long term care insurance products. BushCo wants to shift the risk ("ownership", if you will) of nursing home care from the government to insurance companies, and force as many people as possible into setting up Elder Care accounts for the exact same reason as they want to privatize Social Security - float some more schwag to their investment company sugardaddies.
Medicaid is even easier. The primary consumers of Medicaid are the working poor. The primary consumers of Medicaid simply don't vote in overwhelming numbers. Yes, dramatically cutting or eliminating Medicaid would touch off a social service shitstorm. But let me reiterate - the primary consumers of Medicaid simply don't vote in overwhelming numbers. So tax-cut-and-spend politicians aren't going to really care; in fact, I can see them shifting a portion of Medicare / Medicaid payroll deductions to plug Social Security holes.
The more I hear about the dire straits of Medicare / Medicaid, the more I'm convinced that some variation of the theory I've described is the real strategy behind the Social Security smokescreen.
If this plays out the way I think it might, Left Blogistan is going to have to "rapid respond" as quickly as we have on Social Security. The problem is, there's a whole lot more nuance to Medicare / Medicaid, and any fight to save the intent of either program is going to require exponentially more work. If, as I suspect, there's a fight to be had, we need to think a bit more strategically on the issues. The counter arguments and message have to be fine tuned before the message is needed.
This time, we're not going to have the luxury of "making it up as we go along" as we did with Social Security, because there is no built-in constituency (retirees) or heavyweight advocacy group (AARP) to lean on.
The Medicare / Medicaid fight needs to be battle-planned as if socially responsible progressives in Left Blogistan are going to be the only significant, broad-based organized resistance to the BushBorgs. Because that might indeed be the case.