A handful of Republicans in the U.S. Senate are showing a healthyskepticism about President Bush's plan to slow the growth of Medicaidby cutting 60 billion federal dollars from it over the next 10 years.
The senators are listening to governors - including Republicangovernors - worried about their states if Washington cuts its shareof this essential federal-state health program for the poor.
Yet most politicians and policy experts across the politicalspectrum agree something must change. The cost of Medicaid has grownto $324 billion and - as with every aspect of health care, in boththe public and private sectors - the future promises only higherexpenditures.
Bush may be staking his second-term legacy on changing the SocialSecurity system, but the far greater and more imminent entitlementcrisis is in health care, Medicaid and Medicare. And they merelytrack problems in the overall health-care delivery system, if thenation can be said to have a system, that are driving up costsdramatically for businesses and individuals, too.
Sen. Gordon Smith, R-Oregon, is among the skeptics of the Bushstrategy: Scale back federal support and force states to figure outhow to cope. Smith wants a commission to study Medicaid finances andgenerate ideas that could enjoy bipartisan support on how to keepprogram costs under control.
New thinking is in order - not just for Medicaid, though, but forthe entire health-care 'industry.'
'Market-based efficiencies,' the 1990s solution to spiralingcosts, proved temporary. Today the country's medical bill stands at$1.6 trillion, or more than 15 percent of the economy. And, ArnoldRelman writes in a recent New Republic, the total will continue torise by about 7 percent to 9 percent a year.
No wonder federal and state governments are finding their healthcare program increasingly unaffordable. Who is not?
No one - not Congress, or the administration, or the states - willfigure out how to tame Medicaid costs without looking at the broaderpicture of health care in America.
Relman, a professor emeritus of medicine and of social medicine atHarvard Medical School, makes a strong argument that thecommercialization of medicine underlies its growing deficiencies.Medicine is not just a business like any other, and treating it assuch has made U.S. health care the most expensive in the world, butfar from the most effective.
