By MATTHEW HOLT

It looks like the stimulus package is going to spend a whole lot more on Medicaid AND subsidize the purchase of COBRA for laid off workers. Unlike the “let them eat cake” brigade who’ll decry this as extending welfare to the worthless, I have no problem with it. So long as it really is only a temporary measure,

But let’s be clear—Medicaid is dumb public policy. It’s divided between paying for care for the poor and paying for mostly long-term care for the elderly and chronically disabled, and also has subsidies for hospitals in poor areas thrown in. Then it has S-CHIP as its bastard relation. Furthermore, while the Federal government giveth, the states (which are broke but can’t borrow—California alone is $45 billion in the hole!) are by necessity going to have to take away.

There’s no rationale to have that Federal/state divide on paying for health care for the poor and some of the elderly.

Equally there’s also no rationale for having anyone link their
health coverage to employment—least of all those who are not employed
any more. And don’t forget that COBRA only applies to those who have a
program to buy into. In other words it doesn’t apply for those whose
former employer has gone belly-up taking their health plan with them.

So people need help now, and the stimulus package is about all we
have left. But the temporary stimulus once in place must not become a
reason not to fix the underlying problem with American health
care. We need a single progressively financed insurance pool. When we
get that hopefully employment-based insurance and Medicaid will be a
thing of the past, and not a moment too soon.