04/05/2010 05:12 am ET Updated May 25, 2011

Our Children's Future: Healthcare v. Deficit

Well, health care has gone to the back burner. Now everyone, not just Republicans, is unwilling to talk about it. Allegedly, Democrats are scrambling behind the scenes to figure out a way to pass something, but we are definitely finished having a debate about it.

President Obama revealed his budget today, to the usual "OMG the debt will leave our children with a lower standard of living" from the people across the aisle. Pressed on how he thought the budget deficit ought to be addressed, one of Chris Mathhews' Republican guests admitted that the only way to lower the deficit would be to "transition people 55 and under out of Social Security and Medicare benefits and into a different plan that isn't so expensive." I bet that will be a sure election-winner: work all your life and get kicked to the curb in favor of someone else's grandchild.

Nobody talks about changing the objectives of the system, the delivery, or the costs. All they talk about is the budget deficit and cutting. In the mean time, what's the quality of life for people who need health care now?

In Arizona, where I live for most of the year, Medicaid enrollment has gone up 18% since last year, and the state has one honkin' deficit itself. As a response,

... Governor Jan Brewer, struggling with a $1.4 billion deficit this fiscal year (and a projected shortfall of $3.2 billion in fiscal 2011), ordered the state to stop enrolling children in KidsCare, that state's CHIP program that provides coverage for 47,000 children. Brewer has also introduced a ballot measure that would roll back a 10-year-old expansion of Arizona's Medicaid program, resulting in 310,500 -- more than 4 percent of all Arizonans -- losing their coverage.

It will be interesting to see how long it takes everyone to figure out that if we reformed not the money piece, but the delivery piece, of the health care system, we might be able to provide care for children and the elderly and still decrease the deficit.

I actually do think automating the systems will help a little, and auditing Medicare and Medicaid more carefully and completely will also help. Both programs, according to people I know who have done pilot recovery auditing projects for them, are full of waste -- excess utilization, incorrect billing, duplicate payments. And as for fraud, "60 Minutes" exposed how easy it is to defraud Medicare in Florida several months ago.

There are all sorts of other pilot programs in the bill-that-will-never-be-passed, from the Primary Care Medical Home to prevention to outcomes research. Now most of that will be scrapped, and a paralyzed Congress will just keep trying to figure out how to reduce the deficit on the backs of the vulnerable.

The military budget? Two wars at a time? That might be a little expensive, but why cut back on that? Instead, the budget has been framed as a Hobson's choice: leave our children with debt later, or leave them without health care now. Let's just throw some poor kids out of a Medicaid program and use the savings to buy drones that kill civilians in other countries.