I was having the eery experience of reading a Robert Samuelson column that I more or less agreed with (the “more” being his suggestion that Medicaid be federalized; I am “less” convinced there’s some iron law that such a step has to be “paid for” via a “swap” that devolves federal responsibility for education and transportation) when I came across this passage:
President Reagan actually proposed a swap in 1982. It went nowhere, no doubt because it threatened the power of congressional committees and interest groups. Then as now, the status quo had a stranglehold on the future.
As I mentioned in an earlier post discussing Sen. Lamar Alexander’s effort to revive the idea of a Medicaid-for-education “swap,” this was not something that interested the Reagan administration, which privately suggested a “swap” that would have made states totally responsible for poor people’s needs while the feds would assume responsibiity for the retirees and the disabled. Publicly, I might add, the Reaganites were trying to “cap” federal Medicaid payments, which is much the same philosophy as is reflected in the Ryan Budget’s proposal to turn Medicaid into a “block grant.”
Now, of course, Republicans (presumably including Lamar Alexander, who, despite his “swap” nostalgia, voted for the Ryan Budget) are trying to devolve Medicaid, not federalize it, while also seeking to partially devolve responsibility for the health care of old folks via a voucher system that shifts costs to beneficiaries themselves. But there’s never been much of an appetite among Republicans in Washington to assume greater responsibility–or provide greater uniformity across state lines–for health care for the poor.