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Think of it as a recruiting effort. Think of the bring-the-pain budget Joel Giambra may deliver as a call to a cause.

The cause is the pain Albany -- with its refusal to change -- causes us.

The biggest change Albany can make is in the crushing cost of Medicaid. The bill for public health is killing every county in the state. The acid rain of Medicaid has eaten through rainy-day funds, forced mammoth property tax hikes and prompted piles of pink slips.

Now the corrosion is eating into heart and muscle: libraries, police, parks, museums and community centers. The things that make our lives safer or nicer may be shut or slowed. It's time to wake up and smell the Albany dysfunction.

The Medicaid bill forces Giambra -- and every other county executive -- to do what he doesn't want: cut basics or hugely raise taxes.

It's not fair. It's not fair because the source of the problem -- Albany, where Medicaid costs are partly set -- isn't where the pain or the political fallout is felt. Albany doesn't work, and we pay the price.

We pay the price in higher taxes or in library doors closing. Giambra pays it in political fallout.

Which is why the county executive may toss the political bomb of an all-cuts, no-new-taxes budget in the laps of 15 county lawmakers. It closes libraries, cuts sheriff's patrols in towns, spikes the pipeline of dollars to museums and decimates his own staff.

What seemed for years to be a distant problem -- this thing called Medicaid -- is hitting home. In every home across the state.

By tossing a skeletal, no-tax-hike budget at county lawmakers, Giambra does two things. One, he smokes them out of the weeds, forces lawmakers to go along with the cuts or share the political fallout of a huge tax hike.

"We'll see how (county legislators) respond," said Giambra, "once they hear (from people) about libraries closing and the rest of it."

Two, by putting lawmakers on the same spot he's in, he presumably recruits 15 allies in his fight to point the blame where it belongs -- at Albany.

After five years in office, Giambra is hardly anybody's hero. His pursuit of a pay raise, failure to cut more of the free-car fleet, eagerness to buy office furniture from a friend and the highway department mess left a stain. All of it undercuts his credibility as the Medicaid Express bears down.

But there's no arguing with the Medicaid numbers. The cost of patronage isn't even close. The county's bill for Medicaid rose $66 million the last three years. It sucks up every property tax dollar, and then some.

Maybe the 34 percent tax cut in Giambra's first two years was reckless. But if we make up the 34 percent, raise taxes by that much next year, it brings in $50 million. That doesn't even halfway cover the county's $130 million budget hole.

Add another penny to the sales tax? The $125 million it brings nearly fills the $130 million hole. But three years from now, the bill for Medicaid will be $75 million higher than next year. Where's that money coming from?

A tax hike only delays the inevitable. Albany has to cut benefits to slice the Medicaid bill. Or it has to take over the 25 percent share of bill the counties pay.

Aside from fairness, Albany taking over the counties' share puts the load of costs on the Albany politicians who control them. If they have to raise state taxes to pay for it, the political fallout falls on them. It's the best way to pressure change in Albany.

For all of his faults, Giambra knows that something has to give -- the sooner the better.

The sooner more of us understand that, the better it will be for all of us.


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