Why Medicaid Must Be Run By The States

The selection of Wisconsin Congressman Paul Ryan appears to have energized the Republican ticket politically and, as Mitt Romney had hoped, turned Wisconsin from a lean-Obama state, to a genuine toss-up. Whether the Romney-Ryan ticket retains this momentum and builds on it other states will depend in large part how the GOP handles questions regarding Ryan’s Medicare proposals.

Structural change is required if the vision of Medicare is to survive in the 21st century

I support Ryan’s plan to move to a voucher-based system, but supporting a plan doesn’t mean acknowledging there aren’t some reasonable questions posed on the other side. Foremost among them is the one posed by the left-wing San Francisco Chronicle on their editorial page, which is how t finance this plan.

Over the long-term, the financing will balance out, as the money the government currently spends on Medicare, will simply be replaced by spending it on a voucher, to enable the elderly to choose their own insurance coverage. But like any good idea there are costs associated with implementation—Ryan does not, contrary to left-wing scare tactics, want to alter the benefit structure of any current recipient. Which means the government is financing those plans under the current system, while making the shift to vouchers, at least as Ryan envisions it.

The San Francisco Chronicle charges that the money to pay for this will come from Medicaid, the program for the poor. But this is a prime example of why some programs are better off administered and financed by the states, while others have to run out of Washington. It’s necessary for Medicare to be run by the federal government. The tendency of the elderly to be disproportionate in some states—notably Florida and Arizona—make it unreasonable to have the program run state-by-state. But when it’s possible, state and local governments are better vehicles for delivering services and more likely to responsive to the unique needs that exist in any given state.

Hence, it’s not accurate to say “cut Medicaid” to finance real reform of Medicare. It’s more accurate to say that Medicaid should be shifted into a state-oriented program. When it comes to the federal budget it amounts to the same thing. When it comes to the collective values of the nation, there’s a huge difference between the two ways of saying things—which is, of course, why the left has chosen the less accurate, but more politically explosive way.

How the states handle the financing responsibilities is up to them, but here’s one idea—rein in the politically powerful public unions, the costs of which are exploding. The traditional Democratic Party, built by the New Deal coalition, would never have considered taking medical care from those who have little or are down on their luck, to ensure gold-plated benefit plans for public employees. The New Left is much more willing to entertain the idea. But never let it be said that we can’t have real Medicare reform, while retaining the Medicaid safety net at the state level.

Dan Flaherty is the author of Fulcrum, an Irish Catholic novel set in postwar Boston with a traditional Democratic mayoral campaign at its heart, and he is the editor-in-chief of TheSportsNotebook.com

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