Where is George W. Bush's compassionate conservatism when we need it?

Governor Rounds says increased enrollment in Medicaid may set the state back another $40 million. Candidate Scott Munsterman's solution: kick people off Medicaid.

Munsterman said the state should scale back Medicaid eligibility and provide vouchers to purchase health insurance for catastrophic events.

He also called for more personal responsibility on the part of Medicaid recipients.

“We have a higher rate of medical care within our Medicaid system than other people do who have their own insurance,” he said. “We need to look at deductibles, we need to look at co-pays. We need to have a program that they can engage in, and become responsible, too” [David Montgomery, "Munsterman Says Medicaid Eligibility Must be Scaled Back in SD," Pierre Capitol Journal, 2009.10.27].

More personal responsibility—that's conservative code for not my problem.

Sure, we can probably find folks who take advantage of Medicaid (just like we can find insurance execs who take advantage of their clients... but I don't hear Munsterman calling for dropping the hammer on that system). But the problem the state faces in funding Medicaid is not a sudden surge of goldbrickers. The problem is thousands of responsible South Dakotans who have lost their jobs or/and their health insurance and have nowhere else to turn to get their families decent medical care. They don't want charity; they don't want to face the stigma of irresponsibility that conservatives like Munsterman keep piling onto folks who need help through no fault of their own. But the recession is hammering them, the flu is coming, and they just want to be healthy and not bankrupt.

The proper response from society is to say to these neighbors, "All right, we'll get you through." Candidate Munsterman's response is plain old class warfare—if folks need help, it must be their fault, and they should pay for their irresponsibility.

Practically, his proposal makes about as much sense as cutting unemployment benefits during a recession. It continues the long, sad history of Republican "leaders" unwilling to take the lead on getting South Dakota as a community to recognize our common obligations to each other in tough times. Blame the poor, demand nothing of the well-off: typical GOP.

Update 2009.10.29 07:10 CDT: A reader forwards this breakdown of South Dakota's Medicaid enrollment and spending. The data come from 2006 through 2008, so they don't capture the recession-related surge in Medicaid enrollment. But in FY2006, here's who was on Medicaid in South Dakota:

Medicaid Enrollment	SD	US	SD	US
Total Enrollment, FY2006	118,500	58,714,800	-	-	% of total residents
Children	70,100	29,182,400	59.2	49.7	% of Medicaid enrollees
Adults	20,100	14,879,700	17.0	25.3	% of Medicaid enrollees
Elderly	12,400	6,116,200	10.5	10.4	% of Medicaid enrollees
Disabled	15,900	8,536,500	13.4	14.5	% of Medicaid enrollees

source: State Medicaid Fact Sheet, StateHealthFacts.org, Kaiser Family Foundation, downloaded 2009.10.29

83% of the people Dr. Munsterman thinks need to take more personal responsibility for their health care are children, disabled, or elderly. Evidently the Republican philosophy is to balance the state budget on the backs of those who can't fight back.

...comments and prescriptions for humane public policy welcome at the Madville Times!