Each year when Broome County Executive Barbara Fiala releases the proposed budget my blood pressure goes through the roof. Not because of Barb or her proposals per se, but because the real story is so well hidden in the numbers. I believe politicians either do their best to hide from citizens the fact that we are quickly being bankrupted by Medicaid, or they are in denial, hoping the problem will magically go away.

For those not familiar with Medicaid, it is the immoral requirement that some citizens fork over money to pay for their fellow citizens’ health care. That is, the producers of society, those who work hard and contribute, are forcibly made to hand money to non-producers–those who can’t or (in most cases) won’t work, giving non-producers better health care than the producers themselves have. It is unfair.

Try to locate a single line item identifying total Medicaid payments by reading through the latest 526-page proposed budget for yourself: Broome County Budget – Recommended 2010 (PDF, 54MB). It’s not there. In and amongst the line items you will see something called Social Services, under which Medicaid transfer payments are hidden. Social Services is $113 million out of a proposed $353 million budget (or 32%), and that includes Medicaid, foster care, food stamps and other items.

In the proposed budget you’ll see columns for “expenses” and “revenues” for various line items, including Social Services. How can something like Social Services (and by extension Medicaid) actually generate revenue? It can’t. “Revenue” is a misleading label for what is, in most cases, taxpayer money coming from a different pocket. Instead of the money coming from the “county taxpayer pocket,” it may come from the “state taxpayer pocket” or the “federal taxpayer pocket.” If it comes from any pocket other than the county taxpayer pocket, Ms. Fiala labels it as “revenue.” It makes no difference how you label it–the only way for government to issue money (short of fiat printing it, which spikes inflation), is to take it away from some people (taxpayers) and give it to other people (non-taxpayers). It’s really pretty simple to understand, but completely obfuscated in the proposed 2010 Broome County Budget.

Back to Medicaid in Broome…According to a slide show prepared by Barb Fiala (this slideshow being the only way we know how much Medicaid on its own costs), the county will need to raise and pay $36 million in 2010 for Medicaid. Since the county pays 25% of Medicaid costs (or $36 million for 2010), and New York State pays 25% of the cost, and the Federal government pays the other 50%, that means the total cost (to taxpayers, from all of our pockets) for health care to citizens who won’t pay for it for themselves in (just!) Broome County will be $154 million in 2010. This is obscene and immoral in the extreme. Nationalizing health care will not drive costs down–if anything, the costs will go up. People tend to use services more and scrutinize invoices less when they don’t pay for it themselves. Funny how that works. It’s called human nature.

The only solution to continued tax increases is to cut Medicaid benefits dramatically–not only for everyone in the US, but particularly in New York State. I’ve written about this endlessly over the past few years. Medicaid is the elephant in the room that must be dealt with. Not until New York cuts back on benefits (we have the Cadillac version of Medicaid in NY), will we start to reverse the trend of escalating taxes, with the result that people and jobs leave the state.

What can Barb Fiala do in the meantime? It’s time for bold action. Someone needs to challenge New York State and start reducing Medicaid spending. If taxpayers are footing the bill, we should start acting like an insurance company. Set up review committees to approve procedures and control costs in Broome County. Clamp down on charges from doctors, hospitals, pharmaceutical companies, etc. Make Medicaid recipients (gasp!) responsible for a co-pay–say $25 per doctor visit. Give them an incentive to NOT run to the doctor for every hang nail. Make them fill out paperwork every few months (like insurance companies force us to do) re-certifying they don’t have insurance of any other kind that will cover part or all of their medical expenses. In short, let them experience the same level of hassle that hard working, taxpaying people experience themselves in order to provide health care for their families. Let’s subtly (or not so subtly) encourage them to get a job and get covered.

Think outside the box Barb, and show leadership on the most important issue facing this county! One thing is for sure, if nothing is done about Medicaid, the elephant in the room will surely bankrupt us within a few years.

Technorati Tags: Medicaid, Broome County, Barbara Fiala, county budget, county taxes