Who will we choose �grandparent or grandchild? by the Plain Talk As this is being written, President George W. Bush is getting ready to give his State of the Union address.
He likely will focus on a range of issues, including Social Security reform.
There�s no doubt that if something isn�t done soon, Social Security will be in crisis. We hope, however, that the feds won�t start lengthy debate on this issue at the expense of much more pressing matters.
Like Medicare and Medicaid.
It was noted in last Saturday�s conversations between District 17 legislators and local citizens that a variety of elements � ranging from demographics to federal funding to the mere fact that better medical care is allowing us all to live longer � likely will someday force the state to make some difficult funding decisions.
To be precise: the number of school-aged children in South Dakota is declining. The ranks of middle-aged to elderly adults in the state is growing.
Which group do you suppose will eventually demand more of South Dakota�s financial resources? And where will the money come from?
This week, in a column in the Wall Street Journal, Bob Kerrey notes: �It is at this point in time that the demographic and monetary demands of the baby boom generation will become painfully apparent. The disinvestment in public infrastructure caused by the growth in Medicare and Medicaid will become even worse than it is today. And the nature of this crisis will be considerably more daunting than that faced squarely by Congress and the president in 1983.�
Medicaid growth is being driven by two main factors, both of which are beyond the control of states.
First, the consumer price index for health care has been increasing at two to three times that of the average consumer price index (CPI).
In fact, over the past 13 years, this health care index has increased about 4.5 percent per year.
Second, Medicaid�s caseload growth has increased 35 percent over the past four years. All major categories, including children, adults, seniors, and the blind and disabled, have shot up significantly in that same period.
�While it may be difficult to develop precise projections of the future growth of Medicaid, there are ominous signs on the horizon that the growth of Medicaid expenditures will accelerate,� according to Raymond C. Scheppach, executive director of the National Governors Association. �This will severely impact state budgets and force major cuts in other state programs, particularly education.�
It sounds like South Dakota will be in good company. Many states soon will be forced to make similar decisions, decisions that essentially force governors into the inevitable and unenviable choice of choosing between grandparent and grandchild.
Given that Medicaid is the only safety net available for many Americans, costs undoubtedly will soar over the next decade because of changing demographics and structural changes in the economy that will lead to a reduction in employer-paid health care, according to Scheppach. With its 28 categories of mandated eligibility and 21 optional categories, this 40-year-old state-administered health care program that was created for the nation�s neediest populations is out of sync with the rest of the health care system.
Very simply, Medicaid needs to be radically rethought and completely reformed. As it stands today, it is simply unsustainable.
Medicaid in the future cannot be the only safety net. If it is, more and more states will be forced to pull that net out from under our most vulnerable citizens.
The Vermillion Plain Talk editorials reflect the opinion of Plain Talk editor David Lias. You may contact him at email@example.com