I was starting to write a post about this Ed Koch endorsement of Obama. My plan was to point out what the piece said about Romney’s positions vs. his actual stated positions, highlighting the sometimes subtle and sometimes not-so-subtle distortions of what Romney has proposed.
But I decided not to go into the laborious details, and it’s not just because Ed Koch isn’t that much of a political player any more. Entitlement programs are remarkably complex, and so are any proposed fixes. And of course the law of unintended consequences almost always comes into play. The real point is that there’s almost no way to talk about these matters—particularly things like reforming Social Security, Medicare, and Medicaid, which are the substance of much of Koch’s article—without simplifying and therefore misrepresenting, either deliberately or accidentally or some combination of both.
Many decades ago I took a semester-long course on the welfare system. We had to do a lot of reading about the laws that were current at the time—their flaws, and possible remedies. Then we had to make some recommendations ourselves.
Well, it was a very very sobering few months. The system was deeply troubled, but each fix seemed to introduce other problems. Were the cures worse than the disease? All too often, it appeared so. I developed a healthy respect for anyone who would make a serious attempt to wade into that morass and try to improve it in the real world rather than just the classroom.
That’s what came to mind when I read Koch’s piece. For example, take just this one example Koch cites for his support of Obama:
The Democrats believe Medicaid ”“ health care for the poor ”“ should remain an entitlement, no matter the number of poor qualifying, while Republicans believe Medicaid should instead become a block grant to the states, eliminating the federal responsibility to care for the poor, giving the 50 states the power to decide the benefits to be provided and the funding.
Koch conveniently omits the fact that one of the biggest problems with Medicaid and the federal government is that its regulations now threaten to bankrupt the states, because entitlements that are given “no matter the number of poor qualifying” require a little thing called funding. He also ignores the fact that it’s only the health care law passed in 2010 that’s become known as Obamacare that would cause the states to lose so much of their power over Medicaid in the first place. In fact, he ignores almost everything about the program in order to make it seem to fit the narrative of “Democrats care about poor people getting health care and mean old Republicans don’t.”
Here’s some history:
Until the 2010 enactment of the Patient Protection and Affordable Care Act (ObamaCare), Medicaid preserved state sovereignty and was consistent with the constitutional framework of federalism, despite numerous stringent federal mandates, because the states retained substantial discretion to decide Medicaid eligibility, determine the scope and duration of coverage, and they were free to discontinue participation in Medicaid if not satisfied with the terms and conditions imposed by the program.
At the core of ObamaCare is the individual mandate requiring every citizen to obtain health-insurance coverage with the benefits and provisions specified by the federal government. The way ObamaCare provides for lower-income individuals and families to obtain that required coverage is by forcing the states to offer expanded coverage under Medicaid as a condition of continuing to participate in the rest of the program.
Under ObamaCare, the federal government now imposes Medicaid on the states as a federal mandate to meet the federal requirements of the individual mandate for the entire below-age-65 population with incomes under 138 percent of the poverty line. That includes mandatory coverage for the first time of all non-elderly, childless adults within the income limits. The states, consequently, no longer retain substantial discretion to determine eligibility or scope and duration of coverage for the program within their respective jurisdictions, which makes the program unacceptably coercive.
The result of this coercion will be to increase Medicaid enrollment by 24 million additional beneficiaries by 2015, covering nearly 100 million Americans by 2021 according to the Congressional Budget Office (CBO). The chief actuary of the Centers for Medicare and Medicaid Services estimated that ObamaCare will impose at least another $20 billion to $42 billion in additional costs on the states by the end of the decade, even counting all the federal financing for Medicaid, not to mention other open-ended mandatory costs that are inestimable.
Now, we shouldn’t really expect Ed Koch to go into all that. It would make his task of endorsing Obama so much harder. Nor do Republicans generally present the arguments against their point of view when they’re talking about why they’re supporting other Republicans, either.
But that means voters have to to do their own homework, because they certainly can’t depend on the MSM to do it. And in the case of Medicare and Medicaid reform and so many other things, the issues are remarkably complex, it’s difficult to find trustworthy and unbiased information, and analysis is demanding of skills in math and logic. How many people have the time and the inclination to tackle such a project? And yet without it, we’re at the mercy of the polemicists.
