Opinion

Consider the cost of Medicaid expansion

President Franklin D. Roosevelt signs the Social Security Bill in Washington, Aug. 14, 1935. (AP photo)
President Franklin D. Roosevelt signs the Social Security Bill in Washington, Aug. 14, 1935. (AP photo)

The revival of the Chuck & Nancy show and the renewed calls for “free” healthcare and “free” college make this a good time to recall a central truth of American politics: Republican gains are fleeting, but Democrat victories are forever.

GOP tax cuts and deregulation schemes can be undone with a single vote; Trump’s proposed border wall could be dismantled lickety-split by the next Democrat president.

But the Democrats’ signature achievements — Social Security, Medicaid and Medicare — are now as entrenched as the Constitution.

We can debate whether they endure because they are necessary and good or because so many people are dependent on them. But it’s clear that both parties now consider these programs, which exploded the role and reach of our federal government and account for about half of the national budget, effectively untouchable. This capitulation to the welfare state is a significant reversal for the GOP, challenging the false talking point that it has moved sharply to the right.

Instead, the best true conservatives can do these days is nibble around the edges, such as North Carolina’s refusal to expand Medicaid under the Affordable Care Act.

The left is relentless and will not stop until it wins that battle as well. As they do on so many issues, they try to obscure the hard choices and tradeoffs involved by framing expansion as a moral issue — and, therefore, beyond reasonable debate.

Their party’s new star, Alexandria Ocasio-Cortez (D-NY), expressed this mindset while defending her inability to explain the costs of her democratic socialist schemes. She said, “If people want to really blow up one figure here or one word there, I would argue that they’re missing the forest for the trees. I think that there’s a lot of people more concerned about being precisely, factually, and semantically correct than about being morally right.”

Even morality isn’t free, so before we expand Medicaid — much less add other enormous federal programs — let’s have an open discussion about its costs.

North Carolina’s proponents of Medicaid expansion like to note that the federal government now finances 90 percent of the cost. That does not make it free — because we are the federal government. Thanks to a lack of fiscal discipline from both parties — and the unwillingness of the American people to confront our perilous finances. We are currently running trillion dollar deficits and the national debt stands at around $22 trillion. We can’t pay for the government we have; expansion will just add to the burden of future generations.

Is it moral to stick them with more debt?

A recent report from the National Association of State Budget Officers found that Medicaid represents about 29.7 percent of total state spending in fiscal year 2018. In 2008 it was 20.5 percent. These numbers will continue to grow, sucking up more of our limited funds.

Spending on elementary and secondary education accounted for just 19.6 percent of total state spending in 2018 and studies find increases in public-welfare spending explain why there is less state money for higher education.

Discussion of Medicaid expansion must also reckon with the gross inefficiency of government. California signed up an estimated 366,000 people – at a cost of $738 million – who were not eligible. Louisiana found similar problems.

These numbers have a life of their own, and there’s no going back. But if we were starting from scratch, would anybody argue that Medicaid should be our state’s main priority and biggest expense? Is it more important than funding for schools, roads or some effort to grapple with our trillions of dollars in unfunded liabilities?

Those who say yes should make the case, weighing the benefits and the costs.

Contributing columnist J. Peder Zane can be reached at jpederzane@jpederzane.com.





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