Building Wheelchair Ramps

In today’s NYT, Paul Krugman frets about “state governors who are slashing spending in a time of recession, often at the expense both of their most vulnerable constituents and of the nation’s economic future.”

Krugman’s worries are sparked, in part, by reports like this one, published in Friday’s WaPo:

States from Rhode Island to California are being forced to curtail Medicaid, the government health insurance program for the poor, as they struggle to cope with the deteriorating economy.

With revenue falling at the same time that more people are losing their jobs and private health coverage, states already have pared their programs and many are looking at deeper cuts for the coming year. Already, 19 states — including Maryland and Virginia — and the District of Columbia have lowered payments to hospitals and nursing homes, eliminated coverage for some treatments, and forced some recipients out of the insurance program completely.

Later in that same report, the writers offer a snapshot of the impact in South Carolina where …

Medicaid officials last week announced the third round of cuts since August. They are “real unpleasant stuff,” said Jeff Stensland, spokesman for the state’s Department of Health and Human Services. The program will stop paying for most dental care for adults, eliminate nutritional supplements, cut home-delivered meals from 14 a week to seven, curtail mental health counseling, stop building wheelchair ramps and pay for fewer breast and cervical cancer screenings.

While I appreciate the real human tragedy of these cuts, I can’t avoid the question: “Why was a government program ever paying for items like building wheelchair ramps,* items that private charity can and should address?”

I assume the answer is based, in part, on the gap between scope-of-need and scope-of-private-resources. Or perhaps the answer has something to do with the inability of disparate private charities to identify and address every instance of need. Regardless, my goal in raising the question is not to challenge the funding decisions made by Medicaid officials. Rather, my goal is to challenge private charities (and by extension, each of us) to think about and more diligently plan — now that these cuts are a reality — how we might improve the process of private charity, so that it can more effectively address such needs, so that government can refocus where it should: on the functions that cannot be performed by individuals or private organizations.

And I can think of no better time than an economic crisis to engage said dialogue.

On a personal note, it is questions like these that have prompted my wife and I to consider joining the United Methodist Church, which seems far more concerned with the needs of the downtrodden than with culture-war debates.

* UPDATE: Per issues raised in the early comments to this post, I assumed after first reading the WaPo article — and still do — that the purported cuts in South Carolina, in wheelchair ramp construction, referred to individual/residential situations, not the public-facility requirements of the Americans with Disabilities Act.