Comments on: Kent County and a serious healthcare hit? By Tom Timberman https://chestertownspy.org/2025/02/28/l-kent-county-and-a-serious-healthcare-hit-by-tom-timberman/ Nonpartisan and Education-based News for Chestertown Fri, 28 Feb 2025 21:49:20 +0000 hourly 1 https://wordpress.org/?v=6.7.1 By: Robert Saner https://chestertownspy.org/2025/02/28/l-kent-county-and-a-serious-healthcare-hit-by-tom-timberman/#comment-760538 Fri, 28 Feb 2025 21:49:20 +0000 https://chestertownspy.org/?p=182737#comment-760538 As always, the author’s analysis and commentary are factual and insightful. But the current configuration of the federal/state Medicaid “partnership” is also an object lesson in how the country happens to be awash in annual deficits and accumulated debt. Medicaid was enacted in 1966, part of the “Great Society” but almost an afterthought to the much more ambitious Medicare legislation in 1965. Medicaid was designed to provide healthcare coverage for the very poor–those on cash assistance, particularly the Age to Families with Dependent Children or “AFDC” program. And the premise was that it would be a 50/50 split between states and the federal government with only the poorest sates (e.g. Mississippi and Alabama) qualifying for a richer match. Over the course of the next 50 plus years, it was gradually “enhanced,” almost always through bi-partisan Congressional action and with the best of intentions. And over time two changes stood out. First, a larger and larger share of the costs went not to poor women with young kids but to the elderly in nursing homes needing long term care not covered by the Medicare program. Second, the Federal share of total expenditures grew well above the original equal split. Unlike Medicare which is funded at least in part by a dedicated revenue stream collected as a payroll tax, Medicaid was supported entirely from general revenues, which originally meant tax collections and now translates almost directly into borrowings. And to no great surprise, since that bipartisan Congressional appetite to expand benefits greatly exceeded its appetite to collect taxes to pay for those benefits, deficit spending grew more and more entrenched.

This is not to suggest that I think Medicaid should bear the brunt of efforts to control the deficit. It is simply an example of dozens and dozens of federal programs (in which I include tax incentives) that benefit agribusiness, pharma companies, student loan borrowers, resource extractors, EV manufacturers and on and on. My point, rather, is that until voters and taxpayers hold politicians to a higher standard of responsibility when it comes to balancing the national checkbook, we are destined to fall deeper and deeper into debt.

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