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(DV) Goldsmith: The Medicaid Wars







The Medicaid Wars
by Patricia Goldsmith
June 27, 2005

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While George W. Bush has been conducting his lollapalooza tour for Social Security, the quieter work of dismantling Medicaid has been carried on by the National Governors Association. Right on schedule, the states are starting to feel the first deep hunger pains, the beginning of the end, death by starvation. Grover Norquist, who has said of the states, “I’d like to see them all go bankrupt,” must be savoring the moment.

Saturday, June 11, Governor Phil Bredesen of Tennessee, who is about to cut 300,000 people from his state’s Medicaid rolls, gave a national Saturday morning radio address laying out the anti-Medicaid position: “Uncontrolled growth in the cost of Medicaid is a crisis that’s forcing states to choose between quality health care on one hand and a quality education for our children on the other.”  This is a classic neo-con false premise.  Medicaid costs are 50 percent less than overall health care, which means that rising health care costs for the whole economy are at fault, not Medicaid. And certainly not education.

What is at fault are tax cuts for the wealthy, which are driving scarcity for the neediest among us. By accepting the true underlying premise for Medicaid cuts -- that the wealthiest people in our society deserve to have more and more all the time, even if other people die -- Phil Bredesen is able to put forth a proposal that amounts to the first serious steps toward national health care rationing.

Unfortunately for the poor, the disabled, and children, Phil Bredesen’s talk on Saturday was the Democrats’ weekly radio address to the nation.

In cheery, techno-Dem babble, Bredesen claimed that Medicaid needs to be completely restructured. “[L]et’s launch a new version: Medicaid 2.0.”  He describes his plan with punchy, vivid, sports metaphors: “Until there’s a little economic tension . . . until everyone has a little skin in the game -- the system will continue to be inefficient.”

Unfortunately for all the fundamentalist capitalists, both Democrat and Republican, Medicaid is not a free-market program, nor was it ever intended to be.  As The New York Times explained in a recent editorial (“Gee, Fixing Welfare Seemed Like a Snap,” Gardiner Harris, The New York Times, 6-19-05), Medicaid is a program that is often used in conjunction with Medicare. Changes to one affect the other; just as rising unemployment and poverty rates lead to increases in Medicaid usage.  (In this context, it’s useful to recall that Bush & Co. have already “fixed” Medicare. The provisions of Bush’s new Medicare plan include a specific prohibition against negotiating bulk rates for medicine and billions of dollars in subsidies for private insurance companies.)

“Medicaid is also affected by rules governing private insurance, since anything that makes private insurance more expensive tends to increase the Medicaid rolls.”   Furthermore, The Times continues,

And any ill-considered change could have expensive consequences, say many health care economists. A growing number of uninsured patients might crowd hospital emergency rooms with problems that could have been treated earlier and more cheaply had the patients remained in Medicaid.

To pay for treating the uninsured, hospitals increase rates for the insured. Insurance rates rise.  Strapped employers drop coverage.  And the newly uninsured apply for Medicaid or further crowd hospitals. Some analysts worry that as the ranks of the uninsured grow -- they now number more than 45 million -- the nation may reach a tipping point where the nation’s private health care system starts to collapse.

That’s the cold-blooded analysis, of course, which leaves out all sense of compassion, human obligation, and rights.  Those of us who care about such ephemera, mostly Democrats -- or so I used to think -- believe that social justice is dependent on a balanced budget. That’s Howard Dean 101. And yet the Democratic Party leadership --including, I presume, Howard Dean -- signed off on Bredesen giving this address; it didn’t happen by accident.

Troubling as that is on ideological grounds, it is also politically idiocy, since Bredesen has been accused of “frontloading” his 300,000 in cuts, so that he can put some people back on the rolls right before the election in 2006 and look like a super-hero.  Sharon Cobb, who was once a Bredesen supporter, says she has written evidence of this plan.  Boxes of it, she says.  In an interview with Cobb, Bredesen even admits that people will die from these cuts. You can view her documentary at

At a point in time when the only real distinction most people can see between Democrats and Republicans is the historical distinction laid down by the New Deal -- Democrats protect the social safety net, Republicans cut it -- Bredesen and others in the Democratic leadership want to throw that advantage out the window.

I suspect there are three reasons for this. One, it is just easier. Going the other route would mean constantly pounding away at the Bush tax cuts and railing against the unimaginable economic drain of endless war. Two, there’ s money to be had.  And, three, we’ve got a Democratic Party that is so far to the right that they are often as guilty as the Republicans of confusing democracy with capitalism.

Medicaid is the nation’s largest anti-poverty program. Half its recipients are children, although they receive less than 20 percent of benefits. Seniors take the lion’s share, with expensive end-of-life treatments. If we allow money to be the deciding factor, if we allow the “market” to make this decision, we will be pitting one generation against the other.   The Times editorial concludes with this warning from Representative Joe L. Barton, of Texas: “The emotional debate that we’re eventually going to have to have is the old-versus-the-young debate.”

That is, unless we find the courage to have the-rich-versus-the-poor debate.

Patricia Goldsmith is a member of Long Island Media Watch, a grassroots free media and democracy watchdog group. She is also a frequent contributor to She can be reached at:

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