The House Republican plan to end Medicare is already a political, electoral, fiscal, and substantive fiasco. On the other hand, the GOP’s vision for Medicaid is still very much worth worrying about — not just because it’s worse, but also because the consequences for millions would be severe.

With this in mind, National Economic Council Director Gene Sperling appeared at a fiscal summit today and was asked a good question. A father in Wyoming noted he has a child with special needs, and his family has benefited from government programs. The father nevertheless wanted to know “when does our debt reach the level where good intentions today become crushing burdens on the next generation tomorrow?” Sperling praised the man for being willing to be “part of the shared sacrifice,” but explained “there are right ways and wrong ways to do things.”

“[T]here is enormous discussion about the revenue side and the Medicare side. But from a policy perspective, from a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan. I want to make clear what they are. This is not my numbers, this is theirs….

“[H]ere’s the tyranny of the numbers. Sixty-four percent of Medicaid spending goes to older people in nursing homes or families who have someone with serious disabilities. Another 22 percent goes to 35 million very poor children. Now I ask you, how could you possibly cut 35 percent of that budget and not hurt hundreds of thousands, if not millions of families who are dealing with a parent or a grandparent in a nursing home, or a child with serious disabilities. How is the math possible?

“If you tried to protect them mathematically, you would have to eliminate coverage for all 34 million children. Now I know some people didn’t like when — the President mentioned that this was going to be very negative for families, for those amazingly brave parents. And he may be one of them in our country, who have a child with autism or Down’s and who just are enormously committed and dedicated to doing everything they can to give their child the same chance — every other child has.

“But here’s the reality. Medicaid does help so many families in those situations. Over the years, we’ve allowed more middle class families who have a child with autism to get help in Medicaid. There’s a medical needy program that says when you spend down– we’ll– we’ll count the income after you’ve spent down medical costs.

“There’s a Katie Beckett rogram that was passed by President Reagan that says if you have a child that’s in need of institutional care — you can get help from Medicaid. This is a life support for many of these families. But these are the optional programs in Medicaid. These are the ones that go to more middle class families. If you’re going to cut 49 percent of projected Medicaid spending by 2030, do you really think these programs will not be seriously hurt.

“So when we say that there– that the tyranny of the math is that this Medicaid cut will lead to millions of poor children, children with serious disabilities, children with autism, elderly Americans in nursing homes losing their coverage or being or having it significantly cut, we are not criticizing their plan. We are just simply explaining their plan.”

Jonathan Cohn had a related item on this last week that’s worth checking out, adding some additional context to the Republicans’ Medicaid cuts and the severity of the consequences for those struggling families who rely on the program.

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.