Health Insurance & The Stimulus
As a component of the emerging economic stimulus package, Congressional Democrats are considering an increase in Medicaid matching funds to states. Congressional Republicans and the Bush Administration are reportedly cool to the idea, arguing that public spending on health care has little to do with rekindling the economy. The American public, I suspect, would beg to differ.
Medicaid is a countercyclical program: the need for Medicaid expands when the economy contracts and workers lose private health insurance coverage. Unfortunately for states, who jointly finance Medicaid and who also must balance their budgets, this greater need typically occurs as they experience declining tax revenues, hence the logic for the increased matching funds. But as public and media attention turns to the troubled economy, don't expect health care to be a mere sideshow. Americans intuitively and acutely get that health care and the economy are intimately intertwined, and that health insurance is not only about access to health care services, but also about economic security.
Voters of both political parties tell pollsters that health care is the top domestic issue they are concerned about, and they care most about reducing health care costs and expanding coverage. In a recent Kaiser Family Foundation poll, 41 percent of voters said they wanted to hear Presidential candidates talk about reducing costs while only 8 percent said they wanted to hear about reducing spending on Medicare and Medicaid. Luckily for progressives, the big three Democratic presidential contenders have all put forth detailed, thoughtful health plans worthy of the electorate’s thirst for action on health care (the spirited debate over mandates notwithstanding). So even if issues like Medicaid matching funds in the stimulus package or the battle over SCHIP are only a warm up for what we all hope will be a big push for comprehensive health reform next year, these are battles worth fighting. Progressives should stick to their guns on the issue of Medicaid matching funds, and also take this opportunity to make the case on the larger point: the economic indicators may point to the need for a targeted and temporary stimulus, but the signs of financial distress in family budgets point to long term challenges, and health care tops the list of anxieties.
Comments (9)
While I certainly like this idea better than Bush's tax-cut rhetoric, I worry that--when push comes to shove--these just end up being poor-people's programs. Where's the middle class buy-in? You'd have to pair this with some sort of mortgage relief.
January 18, 2008 7:51 AM | Reply | Permalink
I believe concern over health care costs is going to continue to be a problem long term both for individuals, families and for policy makers in the US.
(No nation on the planet has figured this out)
We must all recognize the reality of the need for both prevention(individual and institutional) and the "R word" =rationing.
But these are perceived as denial of treatment which renders them politically untouchable if promoted too much.
When we implement the imperatives of prevention and rationing- the latter especially at the end of life- we must do this-
- incrementally
- always with compassion
I don't relate this to the short term econonomic stimuuls we need now.
Dr. Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com
January 18, 2008 8:03 AM | Reply | Permalink
We're at a point in discussing stimulus where competing interests will start to emerge. And while I agree with everything you're saying about Medicaid, what about people who want help with rising fuel costs, rising food costs, rising rents and mortgages? I don't disagree with you even a little but I think that people with health care who are struggling in other ways are being left out.
January 18, 2008 10:31 AM | Reply | Permalink
To be sure, health reform is bigger than the stimulus and will require comprehensive change; at the same time, the stimulus is bigger than health care, and will need to encapsulate myriad ways of achieving quick relief. There is a credit crunch and a housing crisis that command immediate and swift attention, and I wouldn't argue that health care should be the centerpiece of the stimulus. But the financial distress that many American families are experiencing is in many ways the result of long-term trends playing out, not just the business cycle, and the slow-motion erosion of the employer-sponsored health insurance system and skyrocketing heatlh care costs are certainly some of the biggest culprits. When you peel back the layers of financial distress at the household level, medical bills show up again and again. So making the Medicaid change may not do a whole lot in itself, but this is also an opportunity to start tying these issues together as we tee up for what we all hope will be a big push for major health reform next year.
January 18, 2008 11:04 AM | Reply | Permalink
agree Cindy Zeldin. People are very scared-justifiably- about accessing affordable health care and we need to address that fear soon.
But we need also to be straight with people about the economic unsustainablity of a high tech-high cost treatment based "disease care" system. Tough but necessary choices ahead.
Dr. Rick Lippin
http://medicalcrises.blogspot.com
January 18, 2008 12:15 PM | Reply | Permalink
I am convinced that struggle to bring forth a universal public health system in the United States on European lines is the decisive battle in reforming the whole US body politic from top to bottom.
For anything to ever really change in the USA, it is fruitless to wait for operatives of the American political system to bring about that change. The reason is simple and obvious: those who hold public office have been able to use the system as it is to their advantage. Why should they want to change it? They will finally rubber stamp the changes that society itself has created through consciousness and action.
Change comes from those who are dissatisfied with the status quo, the quantity of dissatisfaction multiplied by the number of the dissatisfied provides the energy for change. Health care is literally a question of life or death. What greater commitment to change can there ever be than to change the conditions that threaten one's life? It is said that some 40,000,000 Americans have no health coverage: exposed to illness, death and humiliation. Multiply the energy of those 40,000,000 by the desire of those 40,000,000 to live and you have a fulcrum and a lever with which to move the world.
Many who read this will never have experienced such a public health system and may think it an unrealistic utopia. Let me give you an example from the Spanish health care system that I heard about today. I was talking to an Englishman who works as a political analysts for one of Spain's largest, multinational banks. Despite being a young man he suffers from arthritis. Once a month he goes to the hospital where he is given medicine that costs 1000 euros ($1,462.34) a treatment. The system spends about $17,550 a year so that he won't live in constant pain. It costs him nothing. The Spanish economy is doing nicely, Spain just passed Italy in per capita income, people dress well, live in nice houses and eat good food, this is not some "Marxist hell" like North Korea and the system manages to care for the health of all.
It would be interesting to do the math, but I imagine that you could pay for all treatments of all the Americans with acute arthritis forever and ever, world without end. Amen... for the cost of one stealth bomber. For the cost of one atomic powered aircraft carrier you could probably pay for all the generic medicine that all the ill of America could consume in a generation or more. Explain to someone that for the welfare and safety of the homeland he or she must wither away in agony and die unattended. The least they could do is send a Marine Corp bugler to play taps at the funeral of every pauper in America. Theirs is truly a sacrifice! Dulce et decorum est pro patria mori.
To sum up: there is critical mass for change in the American system. This critical mass is the urgent need for basic health care of many millions of people, who can vote, march, organize, go on strike, sit in, chain themselves to public buildings, block roads and do all the things the civil rights movement did in the 60s or for that matter what even Bolivian Indians do today when they want change. There are many teachers of the politics of change, beginning with Ghandi himself, for those who would like to take up the plow without looking behind them.
http://seaton-newslinks.blogspot.com/
January 18, 2008 12:14 PM | Reply | Permalink
Well, this ought to curl everybody's hair....
http://redtape.msnbc.com/2008/01/the-doctor-wi-1.html#posts
January 19, 2008 8:46 PM | Reply | Permalink
I think this is a great idea, Cindy. It's relatively easy to implement too--pretty much tweaking a federal revenue-sharing formula. Since state $ are fungible, this helps free up resources for other stuff too. Also, many state coffers are or will be awfully pinched given the housing meltdown's impact of local tax revenues.
January 19, 2008 4:59 PM | Reply | Permalink
Well, should the 50 states go into the hospital business to ensure 100% coverage? I think for public accountability purposes, they should stop a lot of payments, and consolidate and centralize resources to maximize their effectiveness. Translation: We'll take care of you, but you have to get here, if you don't have money, don't worry about it, 'cause the state has a medical budget. Call it that, in two words, 'medical budget'. You know there's money changing hands to begin with, so make it a lot more efficient. Either that or keep watching some guy on a yacht count his dividend payments from his healthcare company stocks...it depends on which model people prefer....
January 21, 2008 2:24 PM | Reply | Permalink