Congress and the President still have yet to address Medicare/Medicaid reform, even though they all say doing so is essential to the long term economic vitality of the United States. When-- if-- they finally get around to it, the safest bet is to assume, to pick one program, that money helping people live more independently, out of institutions, will be cut. Penny wise, perhaps, but pound foolish.
That route would bring us to how the public money spent should be overseen, to have a minimum of waste and fraud. One way would be to allow bureaucrats to write lots of rules for the recipients of the money to follow. Politicians and bureaucrats are comfortable with that approach, and it's not unreasonable. Another way, however, would be to write fewer rules, allowing more flexibility at the case level to tailor approaches to meet the needs of each individual client, as far as possible, with fewer dollars, and fewer bureaucratic resources. We'll see which approach wins out.
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