Friday, June 7, 2013


If you’re a homeowner you know that Medicaid has a dreadful effect on the overall quality of life of those who don’t use its services. More than half of your Niagara County property tax bill goes towards Medicaid, costing you hundreds of dollars every year. Combine that with what else you put into the Medicaid’s coffers (state and federal income taxes and 1 full percentage point from local sales taxes) and you discover that each Medicaid recipient in New York costs $16,000 per year while the average family of four on Medicaid places a burden of $64,000 on taxpayers.

If you and/or your employer pay for your health care you know those numbers are unreasonable. In comparison, a single-subscriber plan through an HMO is slightly more than $4,000 per year while a family plan is just under $12,000. That’s 75 percent and 81 percent less than their respective Medicaid counterparts.

From the standpoint of equality, that’s a major source of frustration for any reasonable taxpayer. He or she must cut coupons, corners and family budgets to pay for increasingly-costly health insurance and property tax bills, while others are receiving, with minimal effort, Cadillac coverage for free.

But above and beyond the concept of fairness, there’s the issue of fiscal responsibility. How can that same penny-wise New Yorker and the elected officials he or she puts into office take seriously the extravagance – if not waste – of our Medicaid program? Should it really be 4 or 5 times more expensive than private insurance? The answer is "no".

Albany politicians have been talking about Medicaid reform for years, all of them to a man knowing that the system is broken. Yet, the talk has been nothing more than that. If anything, reform has been in the wrong direction, actually loosening eligibility requirements and adding even more pricy gimmicks.

So, how do we change Medicaid and New York State for the better? There is a very simple means to do so, one that would be a win-win for both sides of the aisle (those who demand cost cutting and those fearful of hurting Medicaid recipients): Dissolve New York’s Medicaid system and redirect Medicaid funding to the purchase of private, not public, medical insurance. Call it a Medicaid voucher system if you will. 

The savings would be astronomical. The state’s Medicaid budget is approximately $54 billion. If HMO coverage were purchased, the state would save $39 billion per year and it would totally eliminate the burden that is placed on the counties; gone would be the sales and property taxes specifically set aside for Medicaid.

Residents and businesses would have $39 billion of their own money made available to them every year, allowing them to spend and save and do as they wish with it, pumping it into more-productive sectors of the economy which in turn would increase personal wealth and employ more people (taking them off the Medicaid rolls in the process), making New York a place that’s attractive to live and work.

To make such an idea come to fruition you’d need a buy-in from Albany – our elected officials would have to be willing to totally remodel state government and eliminate layers of bureaucracy. That would be a politically-arduous task.

Another obstacle would be the federal government. Medicaid laws clearly define minimum expectations and requirements. All of those are met by HMO, although the feds might not see it that way. But, any state attorney-general worth his salt can make a very compelling claim to Washington that a privately-managed system is satisfactory. 

A Medicaid voucher plan shows that the ideals of economic development and smaller government can coexist with those of public benevolence and big government: You actually can cut costs in entitlement programs without adversely affecting those deemed to be in need.

Gasport resident Bob Confer also writes for the New American magazine at Follow him on Twitter @bobconfer 

This column originally appeared in the 10 June 2013 Greater Niagara Newspapers

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