arguably the most important and concrete policy difference between the two campaigns. The Medicare changes get more attention on both sides, but Romney and Ryan don’t intend to touch Medicare for 10 years, they swear they’ll honor the Medicare guarantee, and at least in Ryan’s most recent budget, he envisions the exact same long-term spending path as Obama does. By contrast, Romney and Ryan intend to begin cutting Medicaid immediately, and independent analyses suggest that their cuts could throw as many as 30 million people off the program. If you want to see the difference between Obama and Romney’s vision for American policy, it’s probably the single starkest example.Democrats generally give talk of Medicaid short shrift because it's perceived as a program for the poor, and it's a sad fact of American political life that being perceived as channeling government resources to the poor is about as toxic as being perceived as showering largess on the rich. Clinton took care of that by emphasizing Medicaid's middle-class constituencies (as well as children, also politically tonic):
They also want to block grant Medicaid and cut it by a third over the coming 10 years. Of course, that’s going to really hurt a lot of poor kids.As with welfare reform, it's worth noting that this sticking point is personal with Clinton. Medicaid, more than Medicare, was at the epicenter of his own budget battles with Gingrich's Congress in 1995-96. According to Joe Klein's mini political bio of Clinton, The Natural , at a key point in negotiations in fall 1995, Clinton shifted the focus of a confrontation from Medicare to Medicaid:
But that’s not all. A lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid. It’s going to end Medicare as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down’s syndrome or autism or other severe conditions.
And, honestly, just think about it. If that happens, I don’t know what those families are going to do. So I know what I’m going to do: I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen. We can’t.
Dick Armey, a loud-mouthed Libertarian fom Texas, complained that the President was trying to scare his mother-in-law about Medicare. "I don't know about your mother-in-law," Clinton hissed, "butif your budget passes, thousands of poor people are going to suffer because of your Medicaid cuts. I will never sign your Medicaid cuts. I don't care if I go down to five percent in the polls. If you want your budget passed, you're going to have to put someone else in this chair (p. 148).The GOP at that point proposed to cut $182 billion out of Medicaid over ten years. Ryan, as Klein points out, would spend $1.4 trillion less on Medicaid over ten years than Obama. If Clinton seemed seven times as intense as usual last night, that's a large part of why.
I don't suppose "Medicaid, Medicaid, good enough for any old maid" would make much of a bumper sticker. But its central role is funding eldercare in this country needs to be driven home. As well as the fact that the Medicare reform plan in Ryan's budget imposes new burdens on Medicaid even as the same budget guts its funding.