State after state is doing the same thing: balancing their budgets off the backs of the poor, the frail and the old.

Missouri cut 32,600 adults from Medicaid this year and cut some women's health services, such as postpartum care. Kansas reduced home health services. The Mississippi Legislature at one point proposed balancing the budget by cutting 13,000 Medicaid nursing home beds and even overrode the governor's veto, until they reached a compromise after session. They are back now in special session.

The irony is that for every Medicaid dollar cut, the states also lose the dollar federal match.

In Washington, we moved 28,000 immigrants off Medicaid this year to save money. They were offered coverage under the state's Basic Health Plan (BHP), where they share more of the cost, but even that is in jeopardy in 2003 when the state's deficit will be worse.

Medicaid is the fastest-growing part of every state's budget — increasing by 20-30 percent. But, hey, most of these people don't vote or donate to political campaigns.

What are we cutting? Of the 28,000 people we removed from Medicaid this year, 25,000 are children. They don't vote.

And if you are in a Mississippi nursing home, where patients suffer from dementia and require total care, you can bet they don't vote, much less donate. Exactly where will these people go? Or do we care?

Unless changes are made in the existing federal law, 900,000 children nationally will join the ranks of the uninsured. But, hey, children don't vote. If their health interferes with their learning, so what? The fact that literacy has a direct relationship to juvenile delinquency must not factor into these decisions. Besides, the kids will end up in the corrections budget, not Medicaid.

What is ludicrous is the assumption that the "safety net" can serve those without insurance. We have over 700,000 people in this state now without insurance. Who is going to serve them? Hospital emergency rooms? No way near enough space, time and staff, and way, way too expensive.

Physicians? Forget it. Many aren't taking new Medicaid or Medicare patients right now. Their margins are so low they can't afford to treat uninsured patients. So, no room in that inn.

We also face a $300-million shortfall in the account that funds the Basic Health Plan. Where will people go if slots in BHP are lost? Certainly not to Medicaid. Add to this the looming $2-billion shortfall in the state's general fund revenues over the next biennium. This is not only not a pretty picture, it is a brutal one.

So we do the shell game: education, public safety or health care. Your child's school, prisons, or your mom's health care? These are the choices we are forcing ourselves to make. We have locked ourselves into making these either-or choices.

The real tragedy is lack of leadership. Everyone simply says there is not enough money and voters don't want taxes. Everyone is frozen like deer in the headlights of this speeding cost semi-truck, because choices are too hard. We need a new voice.

What really needs to be said is that these are not acceptable choices. We need to have health security, not just social security. We need to be able to protect those in our society who cannot help themselves. Or, we can put our elders on ice floes and wave goodbye.

We are balancing the budget off the poor, the frail and the old. They don't have a voice, don't donate, and many can't vote. Do we really not care what happens to them?

I don't want to live in a society that balances its budget by sacrificing the most vulnerable. But that is exactly what we are doing, state by state across this once great country.

Yes, there are competing needs. So, let's start with setting explicit priorities for what we want as a state and a nation and then collectively figure out how to get there. We have let politics become us vs. them. We have demonized government and each other and have lost sight of what we want as a community and a society. We blame the poor for being so, yet depend on them to take jobs most of us don't want. We don't put people in insane asylums anymore, because the asylums were inhumane; we simply put them on the street and avoid the alleys they sleep in.

We want quality education, but how can you have quality education when children are unhealthy and fail to learn? Are we willing to build more and more jails to house children who become crooks because we never invested in them when they were young?

We're citizens of the same state and the same country, but partisan politics has made us into enemies. We are reasonable people who simply have different points of view. We must start rowing together now to save this ship of state. Otherwise, we will simply be deciding to toss the poor, the frail and the old in the water first, before we turn on each other and sink the boat while fighting to control the rudder.

Kathleen O'Connor writes regularly on health-care issues for The Times. She publishes "The O'Connor Report" and hosts seminars on the health-care marketplace.

Her Web site is: www.oconnorhealthanalyst.com.

Copyright © 2002 The Seattle Times Company

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