RUTHFULLY YOURS

https://issuesinsights.com/2025/05/19/medicaid-end-it-dont-mend-it/

As soon as Republicans mentioned cutting spending on Medicaid as part of their “reconciliation” bill, the usual suspects started rolling out their standard talking points. They’re cutting health care for the poor to pay for tax cuts for the rich! Millions will lose coverage! The disabled will suffer! Oh, the humanity!

Well, if the GOP is going to be accused of destroying Medicaid when all they are proposing is a minor haircut, why not go all out and scrap this hopelessly flawed, fraud-riddled, budget-busting disaster of a program and start over from scratch?

First, let’s dispense with the claim of “devastating” cuts to Medicaid. The House reconciliation bill would reduce Medicaid spending by $625 billion. That might sound like a lot, but it’s stretched out over 10 years, at a time when Medicaid is on track to spend $8.6 trillion. Medicaid spending will still go up every year under the House bill, just a tiny bit more slowly.

What Republicans should really be talking about is giving Medicaid the USAID treatment. Shut it down and start over from scratch.

Let’s line up the reasons.

It was sold on a lie. The original claim made in the mid-1960s was that the federal government and the states would split the cost of Medicaid. But that happened only once: in the program’s first year. Ever since, the federal share has grown while the states’ shares have shrunk. By 2005, states were paying only 42% of Medicaid’s bills. In 2022, the state share dipped below 30%.

Over the past 60 years, states have pressured federal lawmakers to make a multitude of exceptions to the 50-50 split, which lawmakers were only too happy to provide because there is no cap on federal Medicaid spending.

https://www.city-journal.org/article/marijuana-legalization-weed-mental-illness-health

America’s ongoing marijuana-legalization experiment will have many consequences. That goes especially for the seriously mentally ill, a sliver of the adult population but overrepresented among the ranks of compulsive pot users. Treating schizophrenia and bipolar disorder is never easy; even when treatment is available, the seriously mentally ill often fail to comply. A schizophrenic who spends most of his days in a dark room smoking weed is not a clinically promising case.

Modern mental-health systems are community-based and thus shaped by community norms. Decades ago, clouds of pot smoke were not often encountered on city streets. Now that they’re ubiquitous, a seriously mentally ill individual may be inclined to wonder what’s so objectionable about an activity that normal Americans do daily, in public and even during working hours.

The issue is only partly whether pot causes mental illness. A large body of research studies, involving tens of thousands of people, has suggested, with impressive replicability, that heavy cannabis use increases the risk of developing mental illness. Legalization proponents reject this, contending that, while the rate of marijuana consumption has soared over recent decades, the rate of serious mental illness seems to have stayed flat.

But this debate has eclipsed interest in the effect of continued cannabis use on those already mentally ill. What can be done about that? For scores of clinicians and families of the mentally ill across the nation, it’s the more pressing question.

In recent years, countless family memoirs and nonfiction accounts of mental illness have extensively chronicled the descent into madness. This literature often highlights marijuana more than any other intoxicating substance. Pot plays a notable role in several recent book-length treatments of mental illness, including Randye Kaye’s Ben Behind His Voices (2011), Patrick and Henry Cockburn’s Henry’s Demons (2011), Paul Gionfriddo’s Losing Tim (2014), Mindy Greiling’s Fix What You Can (2020), Miriam Feldman’s He Came in With It (2020), Meg Kissinger’s While You Were Out (2023), and Jonathan Rosen’s The Best Minds (2023).