The spending plan put forward this fall by congressional Republicans starkly illustrated that a government budget is not just a fiscal device, but a slate on which moral choices are written.
Take Medicare and Medicaid as prime examples-two programs slated for a combined $440 billion in cutbacks over the next seven years. Medicare and Medicaid are much more than line items on a budget. Medicare provides health care for 37 million elderly and disabled Americans, spreading costs across the whole of society. Medicaid pays the medical bills of one out of every 10 Americans who is poor, disabled, or elderly. The two programs directly affect millions of people in this country: The child whose parents lost private health insurance coverage when they were laid off, the retiree who is hospitalized with a broken hip, the young woman who is left with physical disabilities after an auto accident.
The programs are essential elements of the U.S. health care system. Medicare provides more than half the revenue at many hospitals and at least a third of the revenue of doctors other than obstetricians and pediatricians. The programs are far from perfect-waste, fraud, and inefficiencies occur in both. Nonetheless, changes in these programs will have both immediate and long-term effects on health care availability and cost for all citizens.
For example, the Journal of the American Medical Association reported that Medicaid caps approved by Congress would eventually prevent states from picking up coverage for the growing percentage of children who have lost employer-based coverage. The Senate's spending bill would strip 12 million Americans of health coverage once federal money and state matching funds are exhausted, according to Consumers Union. The group projects that many emergency rooms and trauma centers will close so that hospitals can avoid the costs of increased numbers of uninsured patients, since federal
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