Dead before uttered
Oh, one more thing about Bush's plan to be announced tonight to encourage states to spend more Medicaid to extend health insurance to the uncovered: Apparently, he will want to take this money from Medicaid now flowing to public hospitals that provide care to the uninsured. He wants revene neutality, you see. He'll say it's better to spend the federal matching money for Medicaid on the people themselves for their health insurance than to give it to the public hospitals that treat uncovered people after they get sick. That sounds like a worthy argument conceptually, one having to do with personal responsibility and all; but, in the real-world practice of medicine and politics, it surely will and ought to be a nonstarter to tell places like UAMS that, all of a sudden, they're going to get less money. A better way to go, but it would be costly, perhaps requiring repeal of the income tax cuts on the elite wealthy, would be to spend more in Medicaid to broaden state coverages, and reduce Medicaid payments to public hospitals naturally, over time, by reducing the demand for services to the uninsured because there will be fewer uninsured. A prediction: Though the country needs bold innovation and major reform on health care, Bush is so inconsequential anymore that his pronouncements this evening won't be dead on arrival; they'll be dead before they're even uttered. The state of the Union is not good. It's because of him and his tragic war.