Let 'em eat cake

I'm still into a protracted email conversation with my conservative Republican friend.  As I was about to type this I just saw Sen. Mitch McConnell on TV saying that Americans want him to cut spending.  That may be true, but which spending is he talking about?

I would be thrilled if we cut back on our military spending and the spending on subsidies for huge corporations and industries such as the oil companies, the coal companies, the nuclear industry, and the unnecessary wars we have going on.

But somehow I don't think that's what McConnell has in mind.  He's looking at Social Security, Medicare, the new health care bill and any/all programs that help people.  In the perfect world for these folks who are very well off, there would be no such thing as a social program.  If you can't make do, tough luck.  These guys are the Scrooges and we are the Tiny Tim's, except that there's no happy ending to our story.

Look at this AP story and ask yourself if it makes sense to borrow money from China (or cutting programs for the poor, sick and aged) to give huge tax breaks to people making millions of dollars.  Mitch McConnell has no problem with this and he's now standing up and saying that the American people are on his side.

Are we?

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CHICAGO - In Illinois, a pharmacist closes his business because of late Medicaid payments. In Arizona, a young father's liver transplant is canceled because Medicaid suddenly won't pay for it. In California, dentists pull teeth that could be saved because Medicaid doesn't pay for root canals.

Across the country, state lawmakers have taken harsh actions to try to rein in the budget-busting costs of the health care program that serves 58 million poor and disabled Americans. Some states have cut payments to doctors, paid bills late and trimmed benefits such as insulin pumps, obesity surgery and hospice care.
Lawmakers are bracing for more work when they reconvene in January. Some states face multibillion-dollar deficits. Federal stimulus money for Medicaid is soon to evaporate, and Medicaid enrollment has never been higher because of job losses.

In the view of some lawmakers, Medicaid has become a monster, and it's eating the budget. In Illinois, Medicaid sucks up more money than elementary, secondary and higher education combined.
Medicaid costs are shared by the federal and state governments. It's not just the poor and disabled who benefit. Wealthier people do, too, such as when middle-class families with elderly parents in nursing homes are relieved of financial pressure after Medicaid starts picking up the bills.

Contrary to stereotype, it's the elderly and disabled who cost nearly 70 cents of every Medicaid dollar, not the single mother and her children.

In California, Medicaid no longer pays for many adult dental services. But it still pays for extractions, that is, tooth-pulling. The unintended consequence: Medicaid patients tell dentists to pull teeth that could be saved.
"The roots are fine. The tooth could be saved with a root canal," said dentist Nagaraj Murthy, who practices in Compton, Calif. "I had a patient yesterday. I said we could do a root canal. He said, 'No, it's hurting. Go ahead and pull it. I don't have the money.' "

Murthy recently pulled an elderly woman's last tooth, but Medicaid no longer pays for dentures.
States can decide which optional services Medicaid covers, and dental care is among cutbacks in some places. Last year's economic stimulus package increased the federal share of Medicaid money temporarily. But that money runs out at the end of June, when the federal government will go back to paying half the costs rather than 60 to 70 percent. So more cuts could be ahead.

In Arizona, lawmakers stopped paying for some kinds of transplants, including livers for people with hepatitis C. When the cuts took effect Oct. 1, Medicaid patient Francisco Felix, who needs a liver, suddenly had to raise $500,000 to get a transplant.

The 32-year-old's case took a dramatic turn in November when a friend's wife died, and her liver became available. Felix was prepped for surgery in hopes financial donations would come in. When the money didn't materialize, the liver went to someone else, and Felix went home. His doctor told him he has a year before he'll be too sick for a transplant.

"They are taking away his opportunity to live," said his wife, Flor Felix. "It's impossible for us or any family to get that much money."

Prescription drug coverage in states is an optional benefit, another possible place to cut, Rowland said. "But if you cut back on people's psychotropic drugs, is that penny-wise and pound-foolish? Do they end up in institutions where Medicaid pays more for their care?"

In Illinois, late payments became the rule.  Tom Miller closed his pharmacy in rural southern Illinois this summer and is going through bankruptcy, largely because the state was chronically late making Medicaid payments to him. Most of his former customers are in the program.