If I was asked to name one issue in 2005 that could affect millions of people with disabilities, it is the future of Medicaid. Medicaid, for you laypersons, is a joint federal-state entitlement program that funds health care for millions of low-income and disabled Americans. As a percentage of state spending, Medicaid is beginning to eclipse the other major budget component: education. The Bush Administration is widely anticipated to take on the ballooning costs of Medicaid in 2005. There’s been some talk about making Medicaid into a block grant program. This creates problems for states if Medicaid enrollments unexpectedly rise.
What the Bush Administration is really trying to do is address the massive deficit. Medicaid needs reform, absolutely. But there are other factors that need to be considered. Many states pay exorbitantly high reimbursement rates for prescription drugs. And don’t even get me started on payments to nursing homes. In FY 2003, $45 billion in Medicaid dollars were spent on nursing home care versus $4 billion in community-based services. If states could summon the political will to take on the nursing home lobby, it could result in huge savings for their Medicaid budgets. The role of perpetual institutional bias in our public health care programs needs to be acknowledged if we are really serious about controlling costs.
By the way, Medicare, a 100% federally funded program, doesn’t cover long-term care. In about ten years, that issue is going to reach a boiling point when all the boomers start clamoring for in-home care and state Medicaid funds won’t even come close to meeting the demand.

The devastation left in the wake of yesterday’s tsunami is staggering. Twenty-two thousand people dead and still counting. Someone (a tourist, from the looks of it) took some amazing pictures of the wave crashing into the island of Phuket, off the coast of Thailand. The NYT points out that some deaths might have been avoided if countries ringing the Indian Ocean had established an early-warning system like the one that exists in the Pacific. Most of these nations probably don’t have a lot of spare cash for that sort of thing, but let’s hope the world community chips so that the next time something like this happens, people in the affected areas will have a better chance of survival.

This seemed to be the year of the Duplicate Gift. My sister gave me the Return of the King DVD, which I had already bought for myself. And both my brother and one of my nurses bought me the same book. I’m not sure I’m brave enough to fight the post-Christmas crowds tomorrow. That might wait until Monday.
My family and I went to see The Aviator tonight. Most of what I knew about Howard Hughes came mostly through reading James Ellroy novels, which tended to emphasize his more bizarre attributes. I wasn’t as familiar with his role in developing commercial aviation. Leonardo DiCapprio does a fine job, but his youthful features make it difficult for him to age believably in a movie that is supposed to span twenty years.

As someone who is the product of an interfaith marriage, I appreciate the OC’s contribution the holiday lexicon: Chrismukkah. Even though I’m a Bright and don’t have much attachment to any of the winter holidays, I do have a string of lights hung up in my living room. For me, it’s more about marking the passage of time. This year is coming to a close and a new one will soon begin. I think it’s more than appropriate to take a little time out from the banalities of life, hang out with people close to you, and indulge in your chosen version of merry-making. To paraphrase Scrooge, you keep the season your way and I’ll keep it in mine.
I got a phone call from my sister a little while ago, who breathlessly informed me that she received an acceptance letter from William Mitchell College of Law. A big congratulations to her. I’ll have to begin teaching her the secret handshake. And I should start arranging the requisite midnight initiation rites. Let’s see, where did I put that ceremonial blade? And does anybody know where I can buy a goat for cheap?

Winter sucks. It was in the single digits all day today and, of course, I had to run from location to location for meetings. I know my feet are still attached, but I can’t really feel them at the moment. I need to bug my travel agent about Vegas again. Or maybe I should go back to Miami and find that cute Latina with whom I had dinner last time.
This has to be one of the strangest disability-related stories I’ve read. A porn actress, married to a man with spina bifida, allegedly tried to help him commit suicide. She was put on trial in the UK for aiding and abetting the suicide attempt. Today, the court found her not guilty. She apparently sent her husband a text message days before the suicide attempt that read “Why don’t you get on with it. It would make a lot of people happier.” I’m betting this probably wasn’t the healthiest of relationships. And apparently this guy appeared in films with his wife. I wonder if he needs a stand-in.