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http://www.nytimes.com/2012/10/29/opinion/krugman-medicaid-on-the-ballot.html?nl=todaysheadlines&emc=edit_th_20121029&_r=0
There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more
than 50 million Americans, and which President Obama would expand
further as part of his health reform — will face savage cuts. Estimates
suggest that a Romney victory would deny health insurance to about 45
million people who would have coverage if he lost, with two-thirds of
that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And
this, in turn, means that you need to know something more about the
program.
For while Medicaid is generally viewed as health care for the nonelderly
poor, that’s only part of the story. And focusing solely on who
Medicaid covers can obscure an equally important fact: Medicaid has been
more successful at controlling costs than any other major part of the
nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively
young (because older people are covered by Medicare) and relatively poor
(because eligibility for Medicaid, unlike Medicare, is determined by
need). But more than nine million Americans benefit from both Medicare
and Medicaid, and elderly or disabled beneficiaries account for the
majority of Medicaid’s costs. And contrary to what you may have heard,
the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a
much-needed form of financial aid. It is also, quite literally, a
lifesaver. Mr. Romney has said that a lack of health insurance doesn’t
kill people in America; oh yes, it does, and states that expand Medicaid
coverage show striking drops in mortality.
So Medicaid does a vast amount of good. But at what cost? There’s a
widespread perception, gleefully fed by right-wing politicians and
propagandists, that Medicaid has “runaway” costs. But the truth is just
the opposite. While costs grew rapidly in 2009-10, as a depressed
economy made more Americans eligible for the program, the longer-term
reality is that Medicaid is significantly better at controlling costs
than the rest of our health care system.
How much better? According to the best available estimates, the average
cost of health care for adult Medicaid recipients is about 20 percent
less than it would be if they had private insurance. The gap for
children is even larger.
And the gap has been widening over time: Medicaid costs have
consistently risen a bit less rapidly than Medicare costs, and much less
rapidly than premiums on private insurance.
How does Medicaid achieve these lower costs? Partly by having much lower
administrative costs than private insurers. It’s always worth
remembering that when it comes to health care, it’s the private sector,
not government programs, that suffers from stifling, costly bureaucracy.
Also, Medicaid is much more effective at bargaining with the medical-industrial complex.
Consider, for example, drug prices. Last year a government study
compared the prices that Medicaid paid for brand-name drugs with those
paid by Medicare Part D — also a government program, but one run through
private insurance companies, and explicitly forbidden from using its
power in the market to bargain for lower prices. The conclusion:
Medicaid pays almost a third less on average. That’s a lot of money.
Is Medicaid perfect? Of course not. Most notably, the hard bargain it
drives with health providers means that quite a few doctors are
reluctant to see Medicaid patients. Yet given the problems facing
American health care — sharply rising costs and declining private-sector
coverage — Medicaid has to be regarded as a highly successful program.
It provides good if not great coverage to tens of millions of people who
would otherwise be left out in the cold, and as I said, it does much
right to keep costs down.
By any reasonable standard, this is a program that should be expanded,
not slashed — and a major expansion of Medicaid is part of the
Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill
this success story? You know the answers. Partly it’s their general
hostility to anything that helps the 47 percent — those Americans whom
they consider moochers who need to be taught self-reliance. Partly it’s
the fact that Medicaid’s success is a reproach to their antigovernment
ideology.
The question — and it’s a question the American people will answer very
soon — is whether they’ll get to indulge these prejudices at the expense
of tens of millions of their fellow citizens.
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