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An Entitlement Program By Any Other Name

Plumer and Rosenfeld are both impressed with the clever trick by which Medicare (health care for politically powerful middle class and wealthy old people) gets easily confused with Medicaid (health care for politically weak poor people of all ages, especially children). I agree, but he could have been cleverer. Medicare, as the wonky among you will know, comes in multiple parts. Part A does something, and Part B does something else (I'm not wonky enough to know which is which) and now I think there's been a Part C tacked on. If back when the programs were initially created, however, Medicaid had simply been given the name "Medicare Part C" it would be totally invulnerable to cuts. Note that something similar was done with Social Security where several basically unrelated functions (retirement benefits, survivors' benefits, disability benefits) are all paid out under one label. Sadly, things didn't work out that way. Fortunately, since Medicaid does provide care to some senior citizens (poor ones, to be specific) it's possible for Democrats to discuss potential cuts to Medicaid in terms of their adverse impact on senior citizens. If this should happen to cause the public to think we're discussing Medicare well, then, so much the better.

February 17, 2005 | Permalink

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Comments

Is this really the kind of thing you want to post on a widely-read blog? Can't you see the posts on righty blogs now: "LEFT-WINGERS ADMIT THAT THEIR POLITICAL SUCCESS DEPENDS ON DECEIVING THE PUBLIC." Cite to this post. "Matt Yglesias, for one, makes no bones about his desire to keep the public from knowing what he and his fellow Democrats are trying to do with their tax dollars."

I'm all for it, in substance, but keep this stuff to coffeehouse chats and the like!

Posted by: Chris | Feb 17, 2005 7:38:46 PM

Retirement, disability, and survivor benefits are all SS benefits that are designed to provide something for you or your dependents when you have reduced or no ability to work; I'm not sure I'd call them "basically unrelated".

Posted by: cmdicely | Feb 17, 2005 7:43:01 PM

From this point forward the left has no standing to ever criticize Frank Luntz or other non-socialists for their alleged manipulating of language.

Posted by: Al | Feb 17, 2005 7:48:37 PM

Wasn't that the idea in the early '90s when Dick Gephardt et. al. wanted to offer universal health insurance under the name "Medicare Part C"?

This brings up another bit of trickiness. Currently, the only part of Medicare set to become insolvent (in 2030 or so) is part A, which covers hospitals and nursing homes and is paid for by payroll taxes and the Trust Fund. Part B, meanwhile, which insures all other physician care, can't go insolvent because it's paid for by premiums. (Part C, the drug benefit part, is another story entirely.) But as I recall, back in 2003 the Bush administration wanted to combine the accounting for parts A and B to make it look like the whole thing was going bust.

I don't blame anyone for finding this stuff confusing...

Posted by: Brad Plumer | Feb 17, 2005 7:49:27 PM

"From this point forward the left has no standing to ever criticize Frank Luntz or other non-socialists for their alleged manipulating of language."

Oh come on. There's a big difference between giving two different programs similar-sounding names, and calling, say, a logging free-for-all the "Healthy Forests Act".

Posted by: Brad Plumer | Feb 17, 2005 7:51:36 PM

Oops, sorry, I meant to say Medicare Part B is financed by "premiums and general fund revenues". Blame the lack of a preview function...

Posted by: Brad Plumer | Feb 17, 2005 7:56:24 PM

Jesus, Al. You're so gannon for yglesias, it grosses me out. do you keep a picture of him on your bedroom ceiling?

Posted by: quizically homoerotically al | Feb 17, 2005 8:02:05 PM

Jesus, Al. You're so gannon for yglesias, it grosses me out. do you keep a picture of him on your bedroom ceiling?

That's none of you damn business.

Posted by: Al | Feb 17, 2005 8:05:23 PM

The first Al is all me. Zizka is probably responsible for the second - notice the spelling error.

Posted by: Al | Feb 17, 2005 8:09:17 PM

There is a lot of misperception about Medicaid, including by those who benefit greatly from it, even if indirectly (like the children of seniors in nursing homes). The majority of people enrolled in Medicaid are not senior citizens. So the "face" of the program is young and impoverished, but there is a rather giant caveat: The majority of dollars paid out by the Medicaid program actually go to pay for the care of senior citizens, specifically, those in nursing homes, who require ongoing and expensive outlays for daily care. In some states as much as 80% of Medicaid expenditures go to nursing homes and for other services and supplies paid on behalf of those who are Medicare eligible.

Posted by: Barbara | Feb 17, 2005 8:13:57 PM

"Plumer and Rosenfeld are both impressed with the clever trick by which Medicare (health care for politically powerful middle class and wealthy old people) gets easily confused with Medicaid (health care for politically weak poor people of all ages, especially children)."

Wording does matter, as we can see by Medicare/Medicaid, which is indeed impressive coinage, as well as the extent of Rove's herculean efforts to try to rewrite "private" to "personal".

Clearly Orwellian wording like the "Healthy Forests Initiative" is less effective due to its obvious transparency.

And as long as we're on the topic, I was a fan of Kucinich's coining of single payer universal health insurance as "Medicare for All".

Posted by: Petey | Feb 17, 2005 8:50:03 PM

The first Al is all me.

How embarassing.

Posted by: Toadmonster | Feb 17, 2005 8:55:50 PM

Note that something similar was done with Social Security where several basically unrelated functions (retirement benefits, survivors' benefits, disability benefits) are all paid out under one label.

No, those are more like MediCare parts A, B & C. The Social Secuirty equivilant of Medicaid - the part that helps those too poor to have "earned" it- was given a different name, Supplimental Security Income (SSI).

Posted by: Decnavda | Feb 17, 2005 9:02:17 PM

We're really learning quite a bit about the character of key people in our nation through the debates over Social Security, Medicare, and Medicare.

Unfortunately, I am observing that is a greater lack of integrity and honor among our leadership than I thought possible. Some of these people are not only liars, but thugs and thieves.

We're watching new lows in American behavior.

Is there any wonder why we have credibility problems on the world stage?

Sad, but certainly deserved.

Posted by: Movie Guy | Feb 17, 2005 9:05:52 PM

...Social Security, Medicare, and Medicaid.

Posted by: Movie Guy | Feb 17, 2005 9:08:09 PM

there once was a troll named al
who thought yglesias was his best pal
he gannoned matt's blog
like a marine corps hog
who's selling his tight pectoral

Posted by: fun with irish verse | Feb 17, 2005 9:42:27 PM

Part A covers inpatient hospitalization, while Part B covers outpatient services. Also, Medicaid does have one politically powerful constituency: middle-class (and up) relatives of people in nursing homes, who are being spared most of the expense. (Medicare, contrary to popular belief, provides very little nursing home coverage.) I'm convinced that this is why Medicaid hasn't already been trashed a la AFDC. This is also why I'm very wary of means-testing for SS (take away better-off beneficiaries, kill the program).

Posted by: Rebecca Allen, PhD | Feb 17, 2005 10:50:19 PM

I want to second Rebecca Allen's comments about the importance of Medicaid for middle class families. A few years ago when my grandparents moved to a nursing home, it was quite a lesson for us. My grandfather went first, and soon half of their estate (a reasonable nest egg from selling their farm) was gone to nursing home expenses before Medicaid kicked in. We learned then about "spend down" - the rules of the game for spending your estate before it has to be spent on nursing home care. Basically, making Medicaid kick in sooner. Evidently everyone in the know knew this, but we didn't.

Fortunately, with my grandmother's half we were able to buy a van with a wheelchair lift for my grandfather (whose legs are what put him in the nursing home years before he needed it for any other reason), which added quite a bit of quality to their lives for the last 8 or so years. And without Medicaid, they would have been living with my Mom - not a good situation.

Posted by: Ben V-L | Feb 17, 2005 11:13:25 PM

Brad, the addition of "and general fund revenues" really changes things, doesn't it? I mean, unless you mean to suggest that the general fund is a bottomless source of revenue.

Despite the suggestions oft heard here, all of these programs will be cut. That's as close to a mathematical certainty as there is. They can't continue to grow faster than incomes forever.

Posted by: Thomas | Feb 17, 2005 11:27:22 PM

Where is Ziska, by the way? Does anyone around these parts know where else he might be posting?

Posted by: jjf | Feb 18, 2005 2:11:39 AM

Zizka has been retired in favor of John Emerson.

Posted by: Julian Elson | Feb 18, 2005 7:11:13 AM

Shorter MY: you can fool most of the people some of the time, and the end justifies the means.

Posted by: ostap | Feb 18, 2005 8:28:18 AM

Man, it's not going to be long before you guys realize that Social Security is really there just to keep rich people from having to deal with old poor people.

Posted by: Chad | Feb 18, 2005 9:02:02 AM

I agree completely with Rebecca Allan, that there is a cautionary lesson to be learned from Medicaid about the problems of all means-tested programs.

A central difference between Medicare and Medicaid is that the former is a federal program and a universal benefit, like SS. Medicaid is a joint federal/state program that is essentially for medical indigents, i.e., people who have no resources. Medicare does not cover any costs for long-term care. That falls to Medicaid. You cannot own property and get Medicaid, unless you've been able to put it into the proper kind of trust, and states have made it increasingly difficult to do that. States are often very agreessive in going after property to get repayment for long-term care.

And before anyone pipes up with the usual, isn't it awful that adult children don't look after their parents without help from the government, such comments can only come from those who have never taken a hard look at the costs for long-term care. And even if a family is lucky enough to get help from Medicaid, believe me, as a daughter who wasn't able to during six years spent as the single caretaker of a mother descending slowly into dimentia, paying for assisted living or any other form of long-term care is the least of the demands that are placed on families dealing with parents and grandparents whoare suffering from long-term illness.

As a social worker, I worked with low-income families before there was a Medicaid. The lack of even inadequate health care for such families was nothing short of shocking. The real issue isn't which class of Americans is getting the better health care deal. Every class of American, except the super rich, is getting a terrible deal on their health care, and it's increasingly clear the only answer is some form of national health insurance, or national health care.

Posted by: Leah A | Feb 18, 2005 10:58:16 AM

Regarding the confusion of Medicare and Medicaid -

After 9/11 fueled the invasion of Iraq, I think liberals should generally eschew cheering the conflation, by an inadequately informed public, of issues that supericially appear similar but which are ultimately unrelated.

Posted by: Chuck Smith | Feb 18, 2005 11:10:13 AM

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