Yesterday morning, the Massachusetts Budget and Policy Center released a report illustrating, in chapter and verse, just how much Massachusetts relies on federal dollars to balance its books. “This fiscal year, one of every four dollars that supports the state’s budget comes from the federal government – close to $11 billion in federal funds,” according to the report, [“Partnership in Peril: Federal Funding at Risk for State Programs Relied on by Massachusetts Residents”]. Uncle Sam’s reimbursement for Medicaid spending is the biggest single federal subsidy in the Massachusetts budget. “There is a real risk that Congress could change the basic funding structure of the Medicaid program,” the report warns. “For instance, Congress could turn Medicaid into a block grant, which would be a fundamental threat to the program.”“Partnership in Peril” may be found at:
Only hours after this report appeared, the national press was reporting on the outlines of the proposal-in-the-works from Congressional Republicans to replace the Affordable Care Act, a.k.a. Obamacare. As predicted, and as greatly feared in Massachusetts, the GOP wants to end Medicaid as an open-ended entitlement and convert it to a block grant program. No longer would federal Medicaid subsidies keep pace with the inexorably growing demand here for Medicaid care and services.
Medicaid spending has been increasing in stunning fashion for years now in Massachusetts. The State House News Service reported in January, for example, that, “Over the past decade, enrollment in government-funded health coverage under MassHealth (the name we give to our Medicaid program) has rocketed upwards, growing by 70 percent since 2007 when Gov. Deval Patrick took office…” Today, Medicaid spending represents just over 40 percent of the entire state budget.A federal conversion of Medicaid to block grants would trigger an almost immediate budget crisis. There’d be enormous pressure on the governor and legislature to avoid cutting Medicaid care and services, and to have the state make up the shortfall. From communities large and small, there’d be impassioned cries to increase state taxes to maintain the Medicaid status quo. It could become an office holder’s worst nightmare.
If Baker soon finds himself in Washington, arguing and pleading for a kinder, gentler Medicaid block grant program, I hope what I read the other day on Yahoo, i.e., that New Jersey Governor Chris Christie may soon replace Reince Priebus as Trump’s chief of staff, comes true.Christie’s an old friend and supporter of Baker. With him at Trump’s side, Baker would at least get a sympathetic and respectful hearing in the White House. “…whatever else you want to say about Christie, and I’ve always found him to be a more complicated and gifted politician than his detractors can stand to admit," wrote Yahoo's Matt Bai, "the man knows how to bring focus to a political operation, and how to advance a governing agenda, and how to balance public bluster with backroom pragmatism.” Baker would be quick to agree with Bai, as would I, that Christie’s a gifted politician.
What a remarkable political resurrection it would be if Christie, after losing his bid for the Republican presidential nomination, embracing Trump, then being cast ignominiously aside by Trump’s inner circle soon after the November election, suddenly found himself one of the most powerful men in Washington. The possibility ought not be dismissed. Politics routinely produces such wonderments. The Bai column may be found at:
We need no further proof that Baker is not cut from the same Republican cloth as Trump, but here it is anyway: a comment our governor made to the Lowell Sun earlier this week. “I get the fact that I’m not living in a measured-tone environment,” he said, “but I’m going to model the behavior I believe other folks should exemplify: It’s to be hard on the issues, and soft on the people. Anybody can stand on a corner and shout insults, but what matters is coming into an arena and finding common ground. I wish everyone in politics behaved that way.” [“Gov. Baker: Goal is finding common ground to benefit all,” 2-15-17.]One of the controversies Trump has triggered since taking office concerns the propriety of medical professionals speculating, in the media, on the mental health and stability of the president. An example of that phenomenon may be found in a recent letter to the editor of the New York Times, [“Mental Health Professionals Warn About Trump,” 2-13-17.]
“We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president,” wrote Lance Dodes and Joseph Schachter. Significantly, the letter was co-signed by 33 other psychiatrists, psychologists and social workers.Dodes is a retired assistant clinical professor of psychiatry at Harvard Medical School, Schachter a former chairman of the Committee on Research Proposals for the International Psychoanalytic Association.
I can’t help but lap this stuff up...but not without qualms. Many medicos frown on statements like this because it constitutes diagnosing without directly knowing, much less examining the patient. The other day, I heard one clinician say Trump’s behavior may be disturbing but that doesn’t mean it’s a sign of mental illness, and that in fact Trump is likely not mentally ill because he doesn’t seem to be suffering on account of his temperament. This called to mind a piece of wisdom I once found on the tag of a tea bag: Some people don’t suffer from mental illness, they enjoy it.