Medicaid Cuts & Subsidiarity

by Michael Sean Winters

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[Note to readers: I apologize for the delay. I always try to post by initial blog entry by 9 a.m. but we lost power at my home this morning and it only came back on at 9 a.m.]
Much of the criticism of Congressman Paul Ryan’s budget proposals has focused on his plan to convert Medicare from a guaranteed benefit program to a privatized, voucher system. I agree with the criticism but also wish the critics would go further, point out that Medicare actually is “socialized medicine,” argue forcefully that there are certain things, such as the human dignity of the aged, that should not be left to the vagaries of the market, and make the always salient point that abstract economic theories should not trump immediate human needs in the allocation of societal and government resources.

The reason for the focus on Medicare is that everyone loves it, especially seniors, whose votes in 2010 ushered in a GOP majority in the House and whom the Democrats hope to pull back into their column in 2012. Republicans accuse the Dems of try to “scare” seniors and they point out that the Ryan budget will only affect those under age 55. This is demeaning to seniors, playing to their selfishness. And it won’t work because seniors correctly fear that breaking the social contract invites some other congressman, fresh from a reading of Ayn Rand, to devise some other modification in Medicare later on, all in the interest of creating an opportunity society. Seniors are right to be scared.

The more worrisome cuts proposed by Ryan, however, may be those in Medicaid. This is the program that delivers medical care to the poor. The U.S. bishops have called for a “circle of protection” for the poor in government budgetary decisions. Medcaid makes up a large part of that circle, and so it should not be cut on moral grounds.

There are economic reasons to preserve Medicaid as well. Programs such as Medicaid, among other things, assure a degree of social stability. Medicaid is the largest provider of long-term nursing home care. What would happen to the economy if, unable to pay for care, a woman whose second income is necessary to pay the mortgage, had to quit to take care of an elderly parent? Medicaid pays for most of the health care that is delivered in the poorest urban areas of the country. In a long, hot summer, what would be the effect of child after child going untreated, of poor mothers unable to get medicine for themselves and their kids, of an entire neighborhood suddenly unable to access health care? Medicaid also pays for much of the health care among the rural poor in the South: Just how far behind do Mississippi and Louisiana and Arkansas want to fall on indices of social well-being such as infant mortality rates? Indeed, it is more than a little ironic that the states that from federal social welfare programs tend to be the same states that elect conservatives to high office. There is a degree of hypocrisy in this budget-cutting politics, or a degree of indifference to human needs. Neither speaks well of those who propose it.

The Kaiser Family Foundation has issued a report that details the state-by-state impact of the cuts in Medicaid funding. Their conclusion: “Medicaid’s ability to continue these many roles in the health care system would be significantly compromised under this proposal, with no obvious alternative to take its place.” This last observation is key. Some conservative Catholics have been championing the cuts in the federal budget in the name of subsidiarity. I have argued previously that I think the states should be used as laboratories to experiment with cost-saving measures. But, I have not heard any Republican governors arguing that, in the face of federal cuts, they will increase state funding of Medicaid. It is one thing for the Republicans to say that they want more government programs to be administered at the state and local level, but where are the plans for such administration? I think there is a lot to be said for having tax revenues increase at the state and local level to pay for important social programs, not least because taxpayers would be able to more readily discern what they are paying for. But, no one in the GOP is talking about this. It is just cut, cut, cut and let the poor suffer and the society grow less stable and the rich get even richer. That is not federalism or subsidiarity. It is Social Darwinism.

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