Tag Archives: Medicaid

There and Here, Generation Greed Wants Everything but Refuses to Pay For Anything

Who, in a decade or two, will want the job of changing former President Donald Trump’s diapers, and who will have to pay for it?  

As I’ve said for years, The Donald is THE MAN of his generation.  A generation that came to interpret freedom as freedom from responsibility, to a greater extent than the generations before or after.  For those on the so-called “right,” it was freedom from social responsibility — to the community through paying taxes, to the planet by conserving natural resources, and even, it turns out, to those around them by wearing masks and getting vaccinated.  For those in the so-called “left” it was freedom from personal responsibility, to family members, or non-family progeny, when personal fulfillment, or sexual gratification, or just wanting to get high made that responsibility burdensome.  That has been the story, but not the fact.  In reality Trump, like the majority of his generation, was against any responsibility at all, social or personal.  Eventually, however, he and those of his generation will age to the point where they require custodial care, care that is either hugely expensive or personally draining to provide.  To be provided and paid for by whom?

I bring this up again because it would appear that in the UK, the generation that demanded lower taxes on itself is now demanding additional old age care for itself, paid for exclusively by the less well of generations to follow. Generations already on the wrong end of slashing social benefits for children, while putting a triple lock on a guarantee of benefits for aging adults.  Thus continuing to align Generation Greed’s economic, social and political choices with what, at least here in the United States, have been the personal and family choices of many, if not most.  All while engaging in a culture war to distract attention from what they, collectively, have done.  But there, unlike here in the U.S., generational inequities are at least talked about.

If you happen to be a comedy writer or comedic playwright, hold that thought about Trump’s last days.  I’ll have a suggestion for you at the end of this post, one that could bring 40 years of economic and social trends home to the later-born in a way that perhaps lots of boring data and analysis that you’ll have to get through first does not.

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Hospitals, Social Services, and Housing: Census of Governments Employment and Payroll Data for 2017

Health care vies with elementary and secondary education as the largest destination for federal and state government spending.  In fact, when I added it up in 2006 the federal, state and local governments were already paying for 75.0% to 80.0% of third party (insurance and public program) health care expenditures nationwide, which is to say expenditures other than co-payments and services people pay for themselves in cash (such as cosmetic surgery).  Directly (Medicare, Medicaid, the VA Hospital system) or indirectly (health insurance purchased on behalf of civilian public employees and their families, the exclusion of employer funded health insurance from taxable income, other tax breaks).

Socialized Medicine? Get Real, It’s Already Here

Since then the population has aged, leading to more Medicare and Medicaid spending, Medicaid has been expanded to more working people, and Obamacare has added another form of indirect federal support for private health insurance.  For all the discussion of “socialized medicine,” here in the U.S. the government share of third party health care expenditures is probably up to 85.0% or so, and as a percent of GDP it probably exceeds the cost of the entire health care system in developed countries.

Health care and social services, however, are provided by the government primarily through payments to private sector organizations, generally non-profits in New York City and throughout the Northeast.  Therefore in this, the fifth post based on my tabulation of state and local government employment and payroll data from the 2017 Census of Governments, data on related private sector organizations from the Bureau of Labor Statistics will take center stage.   And this analysis features the most shocking trend I have found so far.

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Health Care and Aid to the Needy: Census Bureau State and Local Government Finance Data for FY 2004 and FY 2014

New York City was long known as America’s welfare capital, with a large dependent poor population and extensive services for them. But one doesn’t hear much about that anymore. New York State has also had the highest Medicaid spending in the United States, but one doesn’t hear much about that anymore either. The data shows New York still spends more on aid to the needy than most other states, as a share of its residents’ personal income, but the gap between New York and the rest of the country closed between FY 2004 and FY 2014. As the gap closed, aid from the federal government to New York shifted to other places. Today, moreover, most of this “social” spending is on health care, and thus on older people, not on those with lower incomes.   A discussion of these trends, with tables and charts, follows.

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State and Local Government Revenues Other Than Taxes: Census Bureau Data for FY 2004 and FY 2014

As noted in my prior post on tax revenues New York State has more of them, at both the state and local level, as a percentage of its residents’ personal income than just about anyplace else. With a particularly high local tax burden in New York City. And New York’s state and local government tax revenues increased as a percent of its residents’ personal income from FY 2004 to FY 2014.


In this post, the data shows that New York’s state and local government revenues other than taxes are also higher than the U.S. average, albeit not to the same extent. New York City’s local government charges for services, and its miscellaneous revenues, increased as a share of its residents’ from FY 2004 to FY 2014, while falling in the rest of the state. The State of New York’s federal aid revenues fell as a percent of state residents’ income during those years, and New York City’s state aid revenues fell as a share of city residents’ income as well. Demographic trends, with school enrollment falling, New York City becoming better off relative to the rest of the state, and New York State becoming better off relative to the rest of the country, may explain this.

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The Phony Federal Campaign and Our Real Future

It is once again time for a major federal election, and I am once again doing my best to avoid listening to the nonsense being spoken by the Presidential candidates. I have not watched any of the past debates, and based on what I hear don’t want to watch any future debates either. Despite our nation’s challenges, the candidates are promising to hand out more goodies, and promising the people who would benefit would never pay for them. Bernie Sanders claims that everyone can have everything, and the only people to pay would be the rich. Ignoring the fact that the Bush tax cut for the rich has already been repealed, and we are still facing a national fiscal disaster. Republicans are once again promising tax cuts for the rich, and promising that the only people who would face sacrifices would be the poor and those in younger generations. The same people Republicans have made worse off in federal policy for the past 35 years, with no acknowledgment of that fact.

Only Donald Trump speaks as if he realizes how much worse off the younger generations following in the wake of Generation Greed actually are. But he doesn’t really explain it, almost certainly doesn’t understand it, and instead panders by creating scapegoats, blaming the Chinese, Mexicans and Muslims for all of the nation’s problems instead. The way the poor, immigrants and those living in older central cities were blamed 20 years ago. And he promises that all people have to do is elect him, and the unsustainable consumer debt-driven phony economy that floated his casinos, before they went under, will somehow return. None of this has anything to do with anything any of them actually would, or could, do if elected. So rather than listen to what they say, I have once again tabulated some federal budget data to what the federal government has actually done over the past 35 years-plus. To see how the choices of the past have affected our real future.

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The U.S. Congress Discovers New York’s Medicaid Program

The federal House of Representatives is not the most popular group of politicians these days, and for good reason. So it must have provided a bit of schadenfreude to write an oversight report about the doings of what ought to be an even less popular body: the New York State legislature.

Click to access Bipartisan-Medicaid-Oversight-Report-Final.pdf

I came upon this report while doing a search to see if anyone had linked on of my posts on Medicaid spending by state, and came upon this 2013 report instead. According to a bipartisan report by the Congress New York State’s Medicaid is rife with waste, fraud and mismanagement. In part because “in the last decade, at least half a dozen elected State representatives, including two State Senate Majority leaders, have been convicted of theft, bribery, or honest services fraud, related to health care.” The fraud was also bipartisan, and both Democrats and Republicans are fingered for blame. So is the federal Centers for Medicare and Medicaid Services (CMS), for its failure to crack down on New York and get the federal government’s money back.

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Medicaid By State and Age in 2001 and 2011

Over the years I’ve noted that New York’s seniors pay far less in state and local taxes than young workers with the exact same income, particularly if they are retired former public employees. And that a huge and soaring share of New York City’s education, police and fire department spending goes to pensions and retiree health insurance. And that New York repeatedly enriches public employee pension benefits for those cashing in and moving out, and then cuts the pay and benefits of new hires.

And that New York has had trouble maintaining, let alone expanding, its infrastructure despite the nation’s highest debt burden. And that in every financial crisis, caused by the fact that those in the inside have deals to get more and more even when tax revenues fall (because the serfs are getting less and less), social services for children are cut first and most deeply – until later when a sensational case of a child being tortured to death hits the news and funding is restored.

Given these other priorities, how would one expect New York’s Medicaid program to operate? Let’s check New York’s Medicaid spending by age group and find out.

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