Block granting certain entitlement programs to the states, namely Medicaid, is a hot topic.  The RSC (Republican Study Committee) led by Rep. Jordan has proposed legislation to effect this.  As anticipated, the usual suspects are crying foul.  You know, the stupid people out in the individual states just simply can’t make the right decisions without the expert’s guiding hand in D.C.  Can’t leave these ignorant and cruel states to their own devices, you know.

But here’s a thought.  The same crowd that is decrying the block granting of Medicaid, is the same crowd that finds favor with the health care system in Canada.  Why does this matter?  Well…ready?...because the Canadian government administers their health care system with block grants to the provinces.  Ouch.  This inconsistency is just too delicious to pass up.  

There’s more.  You see, the Canadian government sends the money to the provinces and when it’s gone, it’s gone.  That’s why they have waiting lists.  Here, Uncle Sam responds to requests for money and what they don’t send is made up for by the states.  All the while, Uncle Sam is telling the states what services they must provide, no matter how much of the difference state revenues must account for.  A certain recipe for budget problems at the state level, and something that would be remedied with block grants.

Think of a Canadian health card like a pre-paid phone card on a party line.  Ever hear your elders talk about the good old days when phones shared a party line, that is, when multiple people shared the same phone line?  That’s Canadian health care.  You have  a pre-paid card, on which millions of others are running up charges, so that at any given time, you don’t know whether the card is worth anything or not.  It is certainly worth less on Tuesday than the prior Monday!  In the U.S., the card has a backup card held by the state governments, the limits of which are being tapped out by the insanity of federal mandates related to Medicaid.  

When I say that the Canadian government sends the money to the provinces, remember where they got it.  They took it first from the provinces.  Messed around a while, took some hookers out to dinner, golfed at various retreats, then sent it back…well…what was left of it.  Having said that, need I point out the obvious:  better not to send it to the thieves in the first place.  

Block grants are a step in the right direction, but just a step.  To stop with block grants is to emulate the Canadian system.  I anxiously await some supporter of Obamacare to tell me why block grants are a great idea in Canada and aren’t here when it comes to health care.

G. Keith Smith, M.D.