Hat tip to Arnold Kling

An article in the WaPo looks at a debate going on at the state level in RI over Medicaid spending. Its state budget bursting at the seams, the state legislature is embattled over what to do with Medicaid, which comprises about a quarter of state expenditures.

As is always the case with such measures, it comes down to the ugly and politicized task of controlling costs and the trade offs are always about cuts in accessibility to certain levels of care in order to sustain the viability of the program.

critics say it would limit access to nursing homes, charge poor families more for medical care and potentially establish waiting lists or cut people from the program. They are now urging the Bush administration to reject the state's request for a waiver to cap its Medicaid spending at about a quarter of the state budget without regard to rising health-care costs or the number of families in poverty.

Governor Ronald Carcieri (R) is optimistic about getting federal cooperation to rein in rising costs in the largest single expense in the state budget.

Again, he stresses the need to cuts in order to sustain the program to make it able to serve the people its supposed to serve in any capacity.

Some of the ideas being floated involve co-pays, reducing certain types of expensive care from the program like nursing home care as well curbing "optional care" like dental care. They say they would counter by increasing the availability of community-based services for the elderly and disabled.

As a refresher, Medicaid works as follows:

The federal government sets minimum standards for whom states must cover and what benefits they must provide. States use their own money, plus matching funds from the federal government, to meet or exceed those standards.

Under the proposal, Medicaid spending by the state of RI would be capped at 23% of the budget...or $754 million. This already short of projected needs that the state cannot meet.

This is the reality of health care entitlement programs. States will face it first and need to react more quickly. They simply do not have the ability to keep changing the window dressing of it and put it off like the Feds do.

Arnold Kling says this is a preview of the upcoming and inevitable battle over these programs at the Federal level where nobody wants to be seen as the bad guy and political expediency keeps pushing it off indefinitely. But it can't continue indefinitely.

Says Kling:

Universal health insurance is a pretend battle. Cutbacks are the real battle. The pretend battle helps to divert attention from the real battle. That is why progressives cannot afford to win the pretend battle.