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Monday, May 05, 2003
Having failed miserably at influencing either public opinion or public policy on the war in Iraq, True Majority has decided to switch topics. Now Ben Cohen, of Ben and Jerry's fame, wants to talk about health care, and he is making just about as much sense as he did when talking about Iraq. Once again, Cohen proposes to flood DC with faxes, this time urging more federal spending on Medicaid. His "personal message" that legions of True Majoritarians should send to their legislators:

Health care that working families depend on is at risk because our state, as well as virtually every other state in the nation, is facing its worst budget crisis in decades.

Editorial note to Mr.Cohen: Momma always said "Tell the reader you are writing the letter in the opening paragraph." Cohen waits until the end of the personal message to tell Your Senator or Congresscritter why he is receiving multiple copies of this missive.

Cohen's proposed message is about sending more money from the federal government to the state governments in order to fund Medicaid. If either of my two faithful readers was hiding under a rock during the HillaryCare debacle early in the Clinton administration, Medicaid is essentially a welfare program. In wonkspeak, it is means tested. In the real world (or New Jersey, should you happen to reside there), that means that if you have too many assets or too much income, Medicaid is unavailable. Period. Find another way to pay for health care. Too much income means about $17,500 annually. Too many assets means $2,000, not counting the value of your home if your spouse lives there, and not counting an additional $1,500 if you have it salted away in a separate account intended to pay the cost of your own funeral. I think its a fairly safe bet that there is a significant number of "working families" in New Jersey who earn $17,500 or less. The provision that really blocks access by most people to Medicaid is the asset limitation. How many "working families" don't have $2,000? People who qualify for Medicaid in New Jersey really are poor, but given the fact that they cannot have even two grand to their name, they cannot fairly be described in general as "working".

The crisis is so severe that children could lose their health coverage, seniors who need nursing home care might not get it, people fighting cancer and heart disease could have to pay more for the medication they need, and anyone who needs urgent care is more likely to face overcrowded emergency rooms. We can't afford cuts like that

There is an old joke about the Lone Ranger and Tonto. They are surrounded by hundreds of rampaging Indians, all of whom are intent on inflicting serious bodily harm on the pair, when the Lone Ranger turns to Tonto and says, "Faithful companion, we are in a lot of trouble." Tonto replies, "What you mean we, paleface?" That covers a large portion of my reaction to a Vermont gazillionaire who says we can't afford something.

The rest of my reaction is: The feds are not even talking about cuts. The issue at the federal level is how much to increase spending on this program. If you want to discuss avoiding budget cuts, it would seem to be more effective to talk to the people at the state level who are actually considering, you know, actual budget cuts.

You have the power to help. You can send more of our federal tax dollars home to our state to protect health care for working families.

Yes they have the power to send more money. No, they can't really help much by doing so. As the Soviet Union discovered, no government can repeal the law of supply and demand. More money will not unwind the vast bureaucracy regulating every aspect of the provision of health care services in New Jersey. More money will not reduce the fraud and abuse known to exist. More money will not reduce the skyrocketing costs faced by health care providers which must be passed along to consumers if the health care providers are to remain economically viable.

No, more money will simply allow our various state governments to continue to do what they are now doing. And the fact is that what our state governments are doing is at least partly responsible for this mess to begin with, in ways too numerous to mention. In addition, Cohen ignores the fact that money is fungible. Providing more money to the states for purpose X allows the states to spend money on purpose Y which otherwise would have been spent on X.

Please stop any federal Medicaid cuts and make sure this year's final Congressional Budget Resolution includes state fiscal relief to put families first.

What federal Medicaid cuts were those, again? I thought the issue was how much to increase federal Medicaid dollars. In fact, that's what even Cohen's site says:

The Senate is considering adding $30 billion dollars to the budget for aid to the states, much of it for Medicaid.

Cohen combines a number of my favorite political tactics. First, the people to talk to about budget cuts are not the ones doing the cutting. Second, a budget increase is really a budget cut. Third, a corollary of one of my father's favorite maxim's, "Let's you and him fight", this is "Let's you and me spend his money." All right, spending other people's money (OPM) is what government does, so I can't really bitch too much about it. But when spending OPM, I think one should, at a minimum, seek to spend it wisely. That means not pouring vast sums into treating symptoms (high prices) while ignoring the disease (high costs, high demand, inadequate supply).

We need to ask whether it is a good thing that we depend on government to provide health care, thus subjecting that health care to the budget crisis du jour. In doing so, we need to look at other examples of publicly provided health care (Canada and the UK come to mind, and the examples are, over all, not good ones) to see what should be copied and what should be avoided. The answer to that question will not be a simple yes, we should do it or no, we shouldn't. Cohen, on the other hand, considers it axiomatic that government should be in the business of providing health care. To anyone, anywhere, at any time, for any reason, because they (we) need it. To Cohen, the answer is so blindingly obvious that it is not even worth the cost of the electrons needed to discuss it.
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