Choice, Not Health-Care Confusion; Republicans Must Avoid the Medicaid morass.(OPED)

Article excerpt

Byline: Robert Goldberg, SPECIAL TO THE WASHINGTON TIMES

Since fighting the Clinton health plan in 1993, Republicans have been largely bereft of any real conviction about medical coverage. Rather, the Republican position can best be characterized - including the expansion of Medicaid and the creation of the State Children's Health Insurance Program - as Ted Kennedy with half the calories. The president is set to lead congressional Republicans in a much different direction - giving Americans the money and tax breaks to choose their own health care and preserve their relationship with the doctors and hospitals they trust.

Democrats will update their version of the Fear Factor (people who are sick, dying or dead without health care coverage) and offer Americans the opportunity to get medical coverage through Medicaid through mandates and higher taxes.

Indeed, the health care issue has never been so usefully defined for the public (or for Republicans and centrist Democrats) in quite some time. The Democrat proposal - shaped largely by its liberal wing with the help of Families USA - bumps up against the state Medicaid programs already facing large deficits and comprising the largest portion of state budgets.

There are already 37 million adults and children served by Medicaid each year and Democrats want to add 40 million more. The idea of having nearly half of all Americans in government-run health programs (if you include 35 million seniors receiving Medicare) might excite Families USA and others, but its unlikely that states will want to take on Medicaid recipients without funding. Medicaid spending is increasing at twice the rate of overall state government spending.

The Democrats will respond with higher taxes - mandates that will require companies to either cover workers or pay into Medicaid. The other "choice" will be "allowing" the uninsured to buy into Medicaid with their own money or federal subsidies - or a combination. But states are already planning ways to scale back Medicaid to save money including limits on who is eligible, cuts in doctors' fees, restrictions on important new drugs, and slashing services to disabled children and the mentally ill.

Unlike people with private health insurance, Medicaid recipients have to fight with other interests for scarce public dollars. Indeed, over the years, Medicaid has become a Hobbesian form of health care, particularly for the mentally ill and children. …