Reject Bushs attack on Medicaid

At a June 13 New York forum titled “Ending the safety net as we know it? Assessing the new federal block grant proposals,” leaders of the Community Service Society (CSS) and the Brookings Institution tackled probably the most important issue facing health, social welfare, and economic policymakers (and average citizens) of our time: the role of the federal government in administering health and social welfare programs.

This issue has been debated for many years, especially since the Reagan administration. Conservatives have been outspoken in their calls to get the federal government out of the social welfare business. One of the Right’s major ideologues on this question, Grover Norquist, once told National Public Radio, “I don’t want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub.” Needless to say, Norquist was thinking about social programs, not the Pentagon.

Reagan pushed this agenda hard, as did the first Bush administration. But even under Clinton there was a willingness to dump federal programs into the laps of the states. This was Clinton’s and the Democratic Leadership Council’s (DLC’s) horrendous concession to the Gingrich Revolution.

Perhaps the greatest attack on people’s well-being was the Clinton administration’s efforts to “end welfare as we know it.” Remember, Clinton’s key appointees to the highest positions in health and human services agency, responsible for welfare rights, resigned when Clinton agreed to gut the federal welfare program. The human devastation that has ensued has been documented by organizations such as the Community Service Society.

The Bush administration now aims to drive the final nail in the coffin of the federal role in Medicaid, a true medical safety net for unemployed and poor people. Under Bush’s program, the federal role in Medicaid, which is 50 percent of the cost of the state Medicaid programs, would be transferred, via block grants, to state governments. State governments could then use that money as they wish.

You can imagine the potential abuses resulting from such a transfer. State governments might decide to use the money for something else, or to distribute it in an inequitable way. As bad as this sounds, the larger implications of such a transfer are even more alarming.

Mark Levitan, senior policy analyst at the CSS, placed the issue squarely: “Block grants change the balance of power. … This is being sold as a technical change. … Well, it’s not just that. This is a shift not just in program design, but in underlying structures, fundamental relationships of power between those, on the end of the spectrum, who really believe that government aid to the poor fosters dependency and those on the other, who feel that poverty is something that public policy should be committed to ending.”

Levitan said that redefining the federal role in Medicaid funding will have the effect of shifting the battleground to the states. “Rather than fighting in Washington, we will do most of our fighting in Albany [state capitals]. Rather than fighting where there are more resources, we will be fighting where there are less resources.”

Levitan directed attention to those time periods where we made the most advances on behalf of people: “The great eras of social progress in our country, the New Deal in the 1930s and the Great Society in the 1970s, were about enlarging the federal role in guaranteeing human, labor and civil rights, and sustaining the poor. That was well understood by the reformers and their opponents in Washington, and it was understood by the activists at the grassroots.”

As we approach the 2004 elections, it is heartening to listen to some of the Democratic hopefuls set aside the Clinton/DLC strategy and move toward a more progressive agenda. Such a shift is probably the reason for the success of Howard Dean, the former governor of Vermont, for example. His antiwar and pro-people message, urging a strong role for government in social programs, is resonating with the electorate.

Clearly, he has struck a nerve that needs to be built on by all candidates for office. Aggressive, mass pressure on all the Democratic Party candidates can yield a program to defeat Bush and his corporate clique.

The author can be reached at pww@pww.org