Medicaid: One size fits all?

Ryan plan sparks Medicaid debate

Paul Ryan, the Wisconsin representative/Republican vice presidential nominee, has brought up a good topic for debate: Should the states or the federal government administrate the Medicaid programs that pay for health care for the poor and the indigent.

That is a good question.

Is it better that the states decide the extent of the Medicaid program and who it helps or doesn’t help, or should that decision be a decision made by Congress, or a federal regulatory agency like the Centers for Medicare and Medicaid Services/Health Care Financing Administration?   Who is the CMMS/HCFA?

Most democratic-socialists will tell you that it needs to be a national program, while most federal-republicans will tell you it needs to be in the hands of the state governments which lie closer to the people. Where you fall out in that debate is the choice you have to make according to what you see the role of government being at each level.

I, for one, tend toward the traditional democratic-republican view point of Thomas Jefferson, even though I dearly love James Madison (and he is one of my personal heroes – even if this is the 100^th year of his disastrous War of 1812 when he shouldn’t have tried to play commander in chief in the field, but that is a whole other story), that government works best when it is closest to the people. In other words, the lower the level of government, the better it works for the benefit of the people.

This is especially true for communities. Communities and their governments, usually municipal or county/parish governments are far more responsive to the needs and desires of their constituents than state governments … and far more responsive than the federal government in Washington. This usually is because the constituents are neighbors to the people running the schools and city halls and let them know their views on their front lawns or over their back fences.

State governments, for similar reasons, usually are little more responsive to the needs of their states than the federal government, but that is partially by design … or malice aforethought, as I put it. Still, state governments can be more reflective and responsive to the demographic makeup and desires of its communities, something that is difficult, if not impossible, at the national/federal government level.

At the national level, in order to avoid being quite arbitrary and capricious in its law and rule making, the government must, basically, make everything “one size fits all.” That, I contend, is a recipe for disaster because problems come in all shapes and sizes and one size definitely doesn’t fit all.

The plan, by those really smart guys way back when, was for each state to be sort of a laboratory of solutions. Each state would try to solve the problems facing its residents, which may or may not be the same or even similar to the ones facing another state. Great idea, but the revolution in telecommunications may have doomed it.

Today, whether it is the Internet or television over cable and satellite, communications are nearly instantaneous, with all problems that are associated with information overload.

One of the complaints in the above article is that advocates for the poor don’t have the resources to go to 50 state capitals to make their cases for greater benefits for the poor and find it much more efficient to take their lobbying to just one place: Washington. But is that not the problem with our national government? Isn’t in the pockets of too many special interests and not looking out for the “general welfare” of the nation?

Of course, the problem with having 51 solutions instead of 1 solution is that it is time consuming and Americans are a notoriously impatient lot. We want our problems solved yesterday, if not sooner, and we don’t like debating over what ought to be done. Just do something, do it now, and make the problem/distraction go away. No need discussing it. No need to come to any compromises. Just do what I want and do it now.

Except sometimes what gets done isn’t what I want, or what my neighbors want, or what might work in some other place but isn’t going to work too well here. Hmmm. Maybe there is a better answer.

As I have said before, government governs best when it governs least, and the best way for that to happen is to leave in the hands of the level of government closest to the people.

Don’t look for that to happen anytime soon, however; the special interests in Washington have no interest in having to work any harder for their causes than they have to.