Originally Published: February 1, 2011 9:46 p.m.
As a first real column upon starting to write them again, I didn't intend to pick such a hot topic - but hey, I don't make the news; I just respond to it.
Cutting Medicaid won't save anything and may actually cost more. The legislators and the governor need big signs kept in front of them that say, "It's not just about the government's books!"
Yes, we face a budget crisis, thanks mostly to unregulated financial gamblers crashing the economy. Some things can be cut and will save money. Some can be cut and cost us in the long run, like cutting education. Health care simply can't be cut. People get sick anyway.
Some savings may be had by people simply toughing out some illnesses. But other problems will just get worse until people have to go to the emergency room and be treated at several times the cost. Emergency rooms which then have to be supported by county or other funds, by higher costs for those with insurance, by higher premiums. We all - that is, the overall state economy - end up paying the price anyway. All that cutting Medicaid does is shift it off the state budget books and sweep it under the rug. Shifts it into the overall state economy. Is that what job the governor and legislators are supposed to be concerned about? Just balancing the state government books and not thinking about the effect on the state's overall economy?
Cutting Medicaid will also cost more because of lost hours for sick people who don't get treatment, because children with treatable conditions may have them develop into chronic ones that will cost us more in the long run, and, oh by the way, because of the enormous amount of matching federal dollars we will lose. The overall economy will have to take care of all these health problems without the help of that money.
It will also cost us more dealing with those who are mentally ill and who genuinely have no family or other way to afford their medications. Yes, it is a handout. That's exactly what it is. It's also a heck of a lot cheaper than having them end up hurting themselves or causing disturbances and having to be dealt with by the police and ambulance and psychiatric facilities and courts, then to be released, go back to the streets and repeat. Cheaper, and humane.
What else to do? In the long run the whole country needs to find a way to reduce the cost of health care, which is the real problem. Till then we'll need to cut where we can, get efficient where we can, but when it comes to Medicaid we just need to raise the taxes and cover it. And they need to be progressive income taxes because combined state and local taxes are already severely regressive.
Yes, I know, I can hear the complaints - "Nobody has the money to be taxed anymore." But follow what I wrote above. We're going to pay for this issue anyway, if not through taxes, then through public support of emergency rooms, higher insurance premiums, etc. It's going to come out of one pocket or the other. If we do it through taxes then we can budget for it, manage it, deliver the care more cost-effectively, work on efficiencies, provide early care so problems don't get worse and cost more, etc. It's a much better way to handle the problem.
I think some people have been hammering away at the budget issue so much that they have the governor and legislators just staring at that bottom line of the government budget till they're hypnotized. They need to look up and around and remember it's a whole state that needs to be thought of. It's not even just about looking at the overall state economy, it's about looking at a bigger picture. The recent vote for the sales-tax increase indicates that people want to take care of their state. Yes, we could just cut our way through this, but people want to get through this tunnel and, on the other end, be proud of how we went through it.
Not just that the economy survived, but that we struck a good balance of tightening up without shutting the door on the sick.