And Now For Something Slightly Different

For all the talk about Social Security, we haven't heard much about the other entitlement on the Bush chopping block -- Medicaid. The plan here is, in many ways, the very apotheosis of the Bush method of governance. Medicare and Medicaid are very different programs, but they both face rising costs for basically the same reason -- the development of new health care technologies leads spending on health care to go up. Medicare is hard to cut thanks to the fact that it's beneficiaries (middle class old people) are politically powerful. Medicaid, whose beneficiaries are poor, is easier to take the ax to. There's no particular justification being offered up for this round of cuts -- the plan doesn't bring about any efficiency gains or anything -- it's just going to deny people health care to make room in the budget for big tax cuts.

What's especially appealing about it from Bush's perspective is that it doesn't require him to actually take anyone's health care away. Instead, he's going to try and cut the amount of money the federal government gives to the states to spend on Medicaid. This will force state governors and state legislatures to cut people's Medicaid coverage, but since each state will have a lot of flexibility in deciding exactly who to screw over and how to screw them, the hope is that governors and state legislators will wind up getting blamed by the voters rather than the president and congress. Nowadays, of course, most governors are Republicans, and they're not going to like this. The issue in play, then, will be whether or not Republican governors have any sway over their states' congressional delegations and senators.