The Little Engine That Could: Medicaid at the Millenium

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Abstract
The Medicaid program is little understood and, often, even less liked. It has suffered from poor design, unintended consequences, massive cost increases, provider hostility, and the slings and arrows of political fortune. Nonetheless, it provides at least some coverage to 1 in 8 Americans and has been a hotbed of health policy experimentation-often for better, sometimes for worse. As it stands at yet another crossroads, its fate is uncertain; yet there does not seem to be anything that could replace it, save a level of social cruelty this nation is so far not ready to accept. The question, then, is how to make the best of Medicaid's tenuous situation-and what we might do to improve it.

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