Medicaid Liabilities

How should Medicaid be treated?  Is it an unfunded liability?  The proponents of Medicaid say no:

Medicaid costs are met primarily by Federal and State general revenues, on an as-needed basis; the States may also rely on local government revenues to finance a portion of their share of Medicaid costs. The Federal financing is authorized through an annual appropriation by Congress. These funds are then spent through daily draws from the general fund of the Treasury in the amounts required to pay that day’s Federal matching amounts on the State program expenditures. As a result, Medicaid outlays and revenues are automatically in financial balance, there is no need to maintain a contingency reserve, and, unlike Medicare, the “financial status” of the program is not in question from an actuarial perspective.
Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/MedicaidReport2012.pdf

So because Medicaid is annually appropriated by Congress it is not an unfunded liability.  However, the "users" of Medicaid certainly have an expectation that it will continue.  I think that to the extent it is in the 10-year budget, it is reasonable to rely on it, and it should be considered to be a liability or debt. (And the flip side is that it is an "asset" to beneficiaries).  And to keep it simple, it shouldn't be discounted to net present value.  So without further ado, here is the Medicaid liability:

So I think this $4.1 trillion should be added to the number I call "systemic debt", which is currently at $81.6 trillion.  So systemic debt is really $85.7 trillion.

And what is the significance of "systemic debt" again? It is most of the debt (and also the flip side, wealth) in the United States and indeed the world.  The "system" has a commitment to paying this debt, or at least keeping current on it.

And that is the heart of our current malaise. "We" are committed to not letting the number shrink (i.e. a foreclosure should lead to a write-down, but instead the bank will keep the zombie property off the market until conditions improve).  But "we" also don't want the number to increase too quickly, or it will quickly become inflationary.  So we are driving with one foot on the break and the other on the gas and wondering why we are not getting anywhere.