Paul Ryan. Paul. Ryan. His speech last night at the Republican National Convention is (probably not) one for the ages, as they would say. Nothing I could write would be more effective than what the blogosphere has already hammered away with here, here, here, here, and oh yeah, here. Unfortunately I don’t have a whole lot of time on my hands right now, but there are approximately two cents that rattled around in my brain (and on Twitter) this morning. They’re based off of John Cohn’s post last night, specifically this part (my emphasis in bold):
Among the cuts Ryan specified was a massive reduction in Medicaid spending. According to a report by the Kaiser Family Foundation and Urban Institute, between 14 and 27 million people would lose health insurance from these cuts. That’s above and beyond the 15 million or so who are supposed to get Medicaid coverage from the Affordable Care Act but wouldn’t because Romney and Ryan have pledged to repeal the law.
I realize conservatives think that transforming Medicaid into a block grant, so that states have more control over how to spend the money, can make the program more efficient. But Medicaid already costs far less than any other insurance program in America. And even to the extent states can find some new efficiencies, the idea that they can find enough to offset such a draconian funding cut is just not credible.
Myself and many others have harped on the prevailing conservative policy aims towards Medicaid. This morning I wrote on Twitter that I’m sure Republicans are very sincere in wanting to introduce efficiency through block-grants into the program. However, as Cohn notes, Medicaid is already extremely cheap. And we’ve talked before what it means to get even more savings out of the program – reduced provider pay, fewer services, and less people enrolled. Now maybe there are efficiencies (however you would define it) to be found. I honestly don’t know.
What I do know is that Medicaid could technically be efficient whether it serves five people in a state or a million. Efficiency, in regards to health care, is a numerically agnostic concept as it relates to enrollees. The approach that Paul Ryan, Mitt Romney, and the Republican Party in general are proposing is first and foremost and avenue towards federal government savings (while the goal of efficiency is left to states). When Paul Ryan talked about “protecting the weak,” this was his vision for the federal governments role in that regard:
Chart via WonkBlog
In my mind I see Paul Ryan et al. envisioning success in the Medicaid program as being measured in terms of their impact on state budgets after being block-granted — and after becoming a stationary, predictable expenditure for the federal government. For some of us Medicaid’s success should be measured by whether it covers those that need it, not whether it hits some arbitrary budget target.