One interesting and perhaps meaningful development in the controversy about the state Medicaid program is the unity in reactions from upstate and down. As local county leaders made clear in a story in the Times Herald-Record on Sunday and as New York City Mayor Bill de Blasio has also said to reporters and to legislators in Albany, this is a state-created problem and should not be solved by punishing cities and counties.
Conflicts between the mayor and Gov. Andrew Cuomo are a regular part of life in New York these days as are conflicts between the governor and leaders of counties, especially those upstate where a decline in population and industry put the kinds of restrictions on municipal budgets that cannot withstand any surprise bills.
But that is exactly what the governor plans, having rolled out a proposal that would punish pretty much everyone in the state for the growth in the Medicaid program which has been out of their control.
The governor has made a messy situation messier. Nothing that comes out of the Legislature in the next few weeks will truly streamline a system that has too many points of entry with too many possibilities for confusion and, worse yet, fraud, and too many unnecessary conflicts. Should we care about the children who need dental work or the elderly who need help to live safely at home?
There is only one true solution to this dilemma. The state should assume all of the costs of the Medicaid program, something that many thought was the eventual goal of the continuing caps and reductions on local shares.
This is the kind of bold move that you would think the governor would embrace. The state could alleviate the bureaucratic burden that now weighs on local governments and make sure there was one standard applicable to all. The state could continue to offer more services than do other states, providing a way for New York to lead the way toward a system of meaningful and universal health care.
And the state could make sure that this expense, by far the largest portion of the state budget and destined to be even larger unless and until the nation starts to implement something closer to universal, single-payer health care, is funded by the most equitable tax available, the income tax.
It also would be a logical next step toward something that is very much under consideration in the Legislature, a statewide health plan providing universal coverage with a simplified single payer.
Had Cuomo proposed this, we now would be considering the benefits as well as the details. As it is, his secretive, incomplete scheme to get more money from localities is not even fully formed. If this is going to be part of the state budget, which is due in a little more than a month, we should be now examining the spreadsheets and the footnotes, not waiting and pleading for him to let us see the details.
The sad truth is that the governor really had no plan to address this shortfall, so he pretended to have one and now is scrambling to fill in the blanks.