Taking the Long View

Once again, determined legislators beat the Medicaid drum at the Capitol on Monday, Aug. 9, when about a dozen of them gathered to demand that Gov. Haley Barbour reconsider his plan to shrink the Medicaid rolls in Mississippi.

This time, the press conference was called by Rep. Omeria Scott, D-Laurel, who said she plans to introduce legislation on the first day of the 2005 legislative session to re-instate the poor and disabled Mississippians that Barbour's plan would shift to federal Medicare in September. Or, Scott said, Barbour should re-prioritize Medicaid and include it in his likely third special session of the year that he may call in September for state economic-development efforts and to reconsider a bonding bill that did not pass during the regular session.

The angry legislators' hands are tied—there is nothing they can do officially until January—but Scott said Barbour should take the initiative. "The governor has another alternative: He can and he should put Medicaid in the call."

Don't count on it. The likelihood of Barbour reconsidering his slash to the state's health care for the poor is growing more unlikely by the day, even as the issue is helping to unite opposition against him and his ideology. At the Neshoba County Fair in July, he made it clear that the feds should pick start picking up the tab: "Mississippi taxpayers shouldn't pay for health-care coverage that the federal government will pay for," Barbour boomed then.

As an ideological Republican, Barbour has long been opposed to government-funded health care either in the states or by the federal government. Some see his apparent attempt to shift the costs of the states to the federal government as an oddity, coming from a leader of a party that claims to be opposed to federal spending on any sort of domestic program or entitlement. Isn't there something a bit incongruous about that statement coming from an, er, small-government Republican?

Not really, if you consider the long-term plan.

In "Agenda for America," a book Barbour authored in 1996 as chairman of the National Policy Forum, he made it clear that sometimes you have to spend more (or pledge to spend more) in the short run in order to shrink certain programs in the long run (or, perhaps, to wrest control away from the states so that you can make those changes, as in the case of education and, probably, Medicare). On the subject of Medicaid and Medicare, Barbour didn't mince words: the health-care programs should be privatized. Employers, he said, should not be required to provide long-term care insurance, but could get a tax break for doing so.

He wrote: "Fraud is high because of the economic incentives in the Medicare system. With Medicare paying the bills, neither doctors nor patients have much reason to make sure that Medicare money is being spent wisely. … As we have seen, the market is not the problem in health care, it is the root of the solution. … Harnessing the virtues of the market—fundamental fairness and freedom—is crucial to any effort to reform health care."

Barbour's plan then (albeit in a pre-war, pre-Bush economy) was that Medicare solvency would be shored up by the federal government and guaranteed until at least 2010 "to preserve Medicare for current retirees and to protect the system for the next generation." However, he wanted a plan to start transitioning Medicare away from government health care and into the private sector: "Today," he wrote, "Medicare and its funds are controlled by the government. The MSA proposal would shift control to retirees—the consumers of Medicare benefits. In the process, it would not only help to solve the Medicare financing crisis, but it would reduce costs to the elderly and actually improve their benefits. … Such reform should be highly appealing to the elderly and everyone else."


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