. . and the Medicaid iceberg

It should surprise no one that Medicaid is the most out-of-control item in the embattled Maryland state budget. Enrollment in the welfare program jumped from 370,000 to 423,000 in just one year -- another grim result of economic hard times. State Health Secretary Nelson Sabatini does not exaggerate when he warns that "Medicaid, if it keeps going in the direction it is going, will drive states into bankruptcy."

It is virtually certain that as health care costs rise, so will demands on Medicaid. In a nutshell, here's what is happening: A worker at a plant like Bethlehem Steel gets laid off, losing health-care benefits. The worker takes temporary work or a lower-paying job with inadequate benefits, or none at all. The worker's family postpones doctor's visits until an illness becomes severe enough to require hospitalization. A single hospitalization soon bankrupts a low-income family. The worker then applies for Medicaid. That's more or less what happened to 6,000 Marylanders who made applications for Medicaid this past month.

The message here should be clear: The issue is not whether we should have some form of universal access to health care in America; we already have it, and it is called Medicaid. And by failing to enact meaningful reform of the system, the federal government simply shifts the burden and cost for health care for the poor and the uninsured to the states.

Such a system is grossly inefficient and only adds to the explosion of health-care costs in the nation. Make no mistake, all citizens ultimately pay the price of this inefficiency because every dollar spent on Medicaid is a dollar that is not available for schools, libraries, highways, aid to strapped cities or most other functions of government. And it will only grow worse until Congress comes up with a comprehensive attack on the problem of health care in America.