Academic medicine is one big shell game. Initially academic physicians are supported by the state, but as their career develops they are expected to get federal grants. We are expected to shift our support from the state taxpayer to the taxpayers of the USA as a whole.
Medicaid is a similar situation. For every $1 the state of Mississippi spends for Medicaid, it gets $3 from the US government. All the local Mississippi politicians treat this $3 as if it is free money, and don't consider the cost to this country and our sky-rocketing national debt.