What about the able bodied trust fund progeny who will be getting estate tax relief? Are they all working? So they will get to pay less taxes, hoard their
fortunes and refuse to work. Talk about "dead end entitlement traps."
6
There is the problem of ageism in hiring. Even those still too young for Medicare in their 50s will be looking for work and will find employers are not interested in older workers. This is blaming the victim for their plight yet again and something that is too prevalent today.
14
Trump cult members/modern Republicans have no "moral education" to offer. The whole point of this exercise to punish the poor, sick, and disabled for being poor, sick, and disabled. With an extra dose of racism, Trumpists would rather sacrifice the well-being of their own families rather than see minorities or legal immigrants receive any health insurance benefits.
12
How many millions in bureaucratic dollars will we spend to police the approximately 7 percent of work-age "able-bodied" adults who do not fall into one of the existing categories.
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=w...
Contrary to popular GOP belief, there are not legions of people leeching off Medicaid. Plus, there's "can work" and there's "hireable." Will employers change their hiring standards?
Poverty is already a handicap. If Kentucky has the training and work programs ready to go, as the gov said, what's prevented them from getting Medicaid recipients on board already?
8
Maine and New Hampshire represent the Self Inflicted Third World of New England. Hard to believe people just 30 miles away me from choose to live like that (ie - vote republican) They can kiss my economic boycott. You get what you vote (pay) for.
1
I have 2 thoughts engendered by this article and some of the comments:
based on republican history, the objective has never been to create a strong social contract between state and individual/community. Rather, shrinking benefits geared to create a healthy, vital and productive population has been the idea. the only purpose of this country in this view, is mercantile, where the nation state is conducted to serve business, energy, multi nationals, financial institutions and well heeled, powerful cohorts. As far as the rest of us go - as Bismark noted, throwing some goodies at the soldiers so they wouldn't flee his army (i.e., giving some social welfare crumbs and stinky job s to the rabble are enough. don't even retrain 'em.) so this is one method.
the other brilliant idea (i don't even know if i'm kidding at this point) is that maybe, now that we've heard unbelievably disheartening anti people junk emanating from republican mouths these last 2 years, kentucky has embarked on a great way to say , low income, needy, old - we don't need you, will starve you. we'll make kentucky so inhospitable to the likes of you that we'll cleanse ourselves of all of you as you die off, or emigrate to california. then we'll be a pure, hard working great state.
I guess articles like this do not encourage about the direction of the country and its policy makers.
2
Training and work incentives are always positive motivators but for those who can work, but for those who absolutely cannot work for various mental or physical reasons, it is unconscionable to cease their healthcare benefits. This will never pass. Americans subscribe to a higher, humanitarian ideal.
2
Have two bouts of cancer, lose everything, then see if you’re still willing to judge. I would love to work.
15
Applies only to able-bodied. If you are not, you should not work.
1
These able-bodied people who would refuse to work with the knowledge that such a decision will result in loss of medical coverage are freely choosing to put themselves at risk for an early death.
2
"A R B E I T - M A C H T- F R E I"
The latest Republican Medicaid policy shift on work requirements is better labeled with the sign from the infamous Konzentrationslager Auschwitz.
Medicaid helps low-income citizens by using Section 1115 waivers to help states give care to individuals & families who need it (via expanded Medicaid). Republicans are proposing the opposite: using the waivers to shrink eligibility, enrollment & justify severe provisions using Orwellian punishment to motivate “personal responsibility”.
If a kid doesn’t do his school work, should his punishment be that he be denied school? If someone gets a speeding ticket should she not be allowed to use our nations highways? If a person has a grease fire on the stove should he not get fire department services in the future? If a person can't contribute to a retirement plan, should she not get future Social Security? If a person uses too much water, should his water be cut off? If a person can't get a job should she be denied health care?
Republican opposition to Medicaid expansion & the demand for work is about cruelty Paul Krugman states: "Making lower-income Americans worse off has become a goal in itself for the modern G.O.P., a goal the party is actually willing to spend money and increase deficits to achieve". Next opportunity you have , reject strident Republicans, Trump & all their corporate backers who have engineered this & other poison policies .
15
It's a matter of principle to the right. Cost does not matter. The right believes in a winner-take-all, kick-'em-when-they're-down, wealth-makes-right society. It is a continuation of the plantation economy. The poor are too lazy, to uneducated to make anything of themselves. So why bother even trying?
The right has successfully demonized the poor and downtrodden. For decades, conservative areas have constantly been told by Fox News and talk radio that people are poor only because they're lazy. Or because they are black and genetically inferior. And having heard little to contradict it, they believe it. They, of course, are the exception that proves the rule. For them, bad luck is the reason. But not for others, especially minorities. They brought it upon themselves.
Thus, Medicaid is a waste of money to them. But not their Social Security disability benefits, not their welfare.
Can't wait for all those Trump voters to start howling.
5
This is an excellent idea - people who are of working age should have to work!!! There are millions of working age people in this country WHO DO NOT WANT TO WORK. They just want to collect -- at the taxpayers (people who do work) expense.
Also, they pay taxes when they work -- that of course is a help to this country.
5
Gotta love Governor Matt Bevin and he needs to get his name out. He’s a management military guru just like all republicans and he has presidential potential. The size of his potential is about the size of the USS Fitzgerald and USS John S. McCain combined.
This is more pure Republican Evil. Just another average day in Trump's America.
7
We are such a messed up country! When you think of healthcare compared to education, why is it that a kid gets free-free-free education even if her parents aren't working and, in fact, the kid is legally *required* to go to school. But for some very sick reason, if that child needs medical attention, tough luck, the kid can die on the streets.
Which I think is the Darwinian perspective of the modern Republican party - "Poor people dying? Yes, what's your point?"
By the way, the effort involved in even discussing how to distribute Medicaid-related healthcare is one of the thousands of reasons why our healthcare system is so very expensive and so barely working.
4
I have worked as a physician in the poorest areas of the country mostly rural but some urban.
If you have not worked among the Medicaid population, you don't understand all the complexities.
There are working poor, unlucky poor, disabled poor- all of whom need and deserve help.
But many of us are sick of the "poor" who continue to make bad choices, do not comply with medical care even though we make resources available to them. There is an entire population of people who suck the system dry. I have no sympathy for the girl in her 7th pregnancy with no education, job, husband. Stop getting pregnant! At the same time we absolutely MUST provide resources to give women control over reproduction.
Disabled? Most recently a man who said he had too much neuropathy in his hands to continue as an auto mechanic. But he prided himself on his hunting and fishing abilities-and with no apparent recognition of irony told me he had no trouble loading and shooting his multiple weapons.
Those who need to get off the dole may not be the majority of those on Medicaid, but when you interact with that population on a daily basis, you will be a tad jaded and maybe more realistic that we have a problem with the entitlement programs.
And to those of you who don't know how the system works- I have never in my 35 years of oncology seen any patient not treated for their cancer . We always find a way and the drug companies usually provide or replace the drug for free.
7
As a society, we are clearly going down a rabbit hole. Not every person receiving Medicaid is working the system. What of seniors, who, through no fault of their own, find themselves needing assistance? What about the disabled? And, what about the mentally-challenged?
There are so many other federal programs needing our attention and overhaul.
I would love to see the fraud removed from Medicare. Why aren't we actively pursuing all the tax cheats in our country? Medicaid, while problematic, is only a small piece of the utter corruption of our social services.
As a country, we are only as strong as our weakest inhabitants.
5
But GOP thinks it is OK to eliminate access to abortion, even in cases involving rape, child sex abuse etc.
6
Imagine a young man on the autism spectrum who has such incapacitating social anxiety that just going grocery shopping or to a doctor's appointment can be completely overwhelming, causing him to shake all over and stay hidden for a week afterwards. Medicaid could help that young man get the help he needs so that eventually he can work. He wants to work; he wants to be productive; but he has a major disability (that may not be immediately obvious). Cutting him off from medicaid could just cause him to commit suicide. Is that really pro-life??!!
12
Nobody is going to cut off people who cannot work. Only those who don't want to.
2
The USA has always had 'morality' judgments about the poor, haven't we? The scale tips from one to the other frequently.
One side of the scale has 'morality' on the side of the society at large and suggests that the act of helping the poor is the 'moral' thing to do.
The other side has the 'morality' suggesting that the poor are slothful and need to go to the work farm to earn their bread.
And so here we are. Back to the work farm for the poor once again. The safety net gets shredded and please remember that the clock tolls for thee too. Someday you or a friend or a relative may need help and the requirement will be that you, your friend, or your relative become 'moral' and get to work.
In America, health and health insurance only come as a result of work. Even social security and medicare have their 'work taxes' to pay for the safety net.
Hmmmmmmmmmmmmmm. One might say that the USA is a 'sick' and 'immoral' society, couldn't one?
6
You didn't comment on this in the article, but does Kentucky have any requirements to be on the Death Panel that will decide who to cull? I scoffed at the suggestions of the ACA including death panels when the brilliant Alaska governor and Iowa's senior senator brought that up in 2009. Little did I realize that the GOP would end up establishing the DEATH PANELs in 2017.
Again, do we need any more evidence that America is not a Christian country?
13
"No work, no eat." - Jamestown, 1607
People who can work, should work. Arguing otherwise is not liberal or progressive, but "the bigotry of low expectations."
4
This isn't Jamestown, a colony of the damned in the middle of nowhere. It's 400 years later in the middle of the richest civilization we have ever produced.
11
I want everyone to have great medical insurance. In this article, however, the breast cancer paragraph is alarmist and wrong.
The breast cancer " statistics" are very loose; "a distant stage"? And the worst: "Waiting for 60 days or longer to get treatment raises the risk of dying from breast cancer over five years by 85%. That is a frightening thing to say and just plain wrong for "early stage" (stage 1&2 ) breast cancer. First of all, by the time you are diagnosed you have had cancer for many months, likely more than a year. Many, if not most women, have surgery weeks after being diagnosed.That statement could unnecessarily frighten newly diagnosed women and cause them to rush into a treatment that may not be right for them. I have great medical insurance but I did a lot of research before deciding on a treatment and the hospital where I would be treated. That took time - about 5 weeks from biopsy to surgery. No doctor told me I was risking my life by taking the time. No surgeon tried to rush me into the operating room. That said, an exception is inflammatory breast cancer, which does not have an early stage and requires immediate treatment. But that is a rare diagnosis. I found the research the author is citing and what the research found was that waiting 60 days or longer after biopsy for treatment of * late stage* breast cancer can raise the rate of death during the first 5 years by 66-85%. Not mentioning "late stage" is a big omission. Please be accurate.
2
If this article is intended to tell us that people are going to die as part of the consequences of the Republican Party's current war on the common American, well done. If there is any suggestion either in this article or in ANY comment to be made in the future that these consequences are unintentional, I have an entire continent to sell you.
7
Able-bodied people have a choice: work or increase your risk of dying early.
1
Solidarity and compassion, Republican style. Perhaps cleaning houses, mowing lawns or washing cars for the 1% in exchange for healthcare is next? Appalling.
8
Why not? Better than sitting around doing nothing.
3
It is all about saving money so that the rich can get more money from the government.
In NC I applied for disability and the State examiners , who are paid to claim that one can work, of course ruled against me. AFter five years of fighting a judge ruled that the state doctors were totally unbelievable in less than one hour and I finally received benefits. Of course by that time I had lost everything. Oh one doctor ruled that I was totally unable to work any job but he was removed from their list of "approved" and I was forced to sesee one of their approved deniers.
The same "doctors" make the rulings for medicaid and of course rule against the disabled. My mom was ruled as able to work and she was totally blind on one eye and 90% in the other.
6
I pay six hundred a month for medical care that I need to pay for. Liberals have yet to make an argument why other able bodied people can't do at least some work each month to pay for their own medical care.
5
I'm a liberal (or moderate) and I strongly believe that able bodied people should work or volunteer time to clean up parks, sweep sidewalks, pick up trash, or anything else that (safely) needs doing to get any type of welfare benefit. If I can work all my life (and have had three jobs at once to get by when younger), pay taxes and help those in need, they can work too, no matter what the wage is. I'm not sure what the author's alternative solution is - just let people sit home watching TV and collecting health and other benefits instead of contributing in some way to society?
4
There is nothing wrong with the idea of requiring some form of work or job training for able, unemployed people on Medicaid but, as usual, the devil is in the details.
Using the New Deal's W.P.A. and C.C.C. as models to be adapted might benefit both the aid recipients and the community at large. The important thing is that the training and work provided by the states be meaningful and accessible. The WPA built Hoover Dam, while also supporting Jackson Pollock's art. Meanwhile, many of the best structures still gracing our Parks were built by the CCC, as they employed and trained many Americans.
Yes, we must be prepared to fight for good programs, but to simply reject out of hand the idea that those receiving public aid should be exempt from providing some form of public service consonant with their physical and mental circumstances is self-defeating in the long run. Done right, programs can provide much-needed training, create public goods, and garner support from taxpayers who might otherwise oppose entitlement programs.
Porter's Tennessee examples demonstrate what to avoid, not that there should be no program. Let us support state efforts to devise good programs, while fighting to make them useful and fair. Yes, they will be experiments, and some will work while others will not, but that is how we learn to improve what we do. Remember, Obamacare essentially started out as a state program instituted by a Republican governor.
To repeat, the devil is in the details.
10
I am no doubt alone in this view, but using mortality rates as the only metric for deciding policy is risky. If we believe that ultimately the government's responsibility is to lower mortality, then that opens the flood gates for many things that can be done to achieve that end. Eliminating tobacco and firearms are the low hanging fruit that is guaranteed to lower mortality. Traffic laws, product safety and many other things also are in play.
The point here is that all governments balance intrusion and expense against mortality when deciding policy; it is always possible to trim a few deaths by making everyone drive less than 50 MPH on freeways, but we don't, we accept the deaths as the right balance point and let people drive 70 MPH. The same should be true with healthcare. It sounds harsh but we already accept the reality that government policy is not one of zero-deaths.
As long as the balance point for the Medicaid work requirement is for the most part only pushing people off Medicaid who make a decision not to work rather than cannot work due to physical/mental reasons, I think that the policy is OK, even if it results in a higher mortality rate.
3
you assume that a job exists for every worker in poverty, which means a job exists within easy walking distance such that workers can arrive at work in any weather presentable to work.
the GOP never supports public transit that is available to all that matches with work schedules. Uber does not solve the transportation problem for people unable to afford a smart phone. the GOP doesn't even support providing safe infrastructure for people walking or riding bikes.
imagine not having a car. How many job opportunities would you have?
16
Some are so sure that these people are shiftless and unwilling to work. I suspect thar thought stems from feeling like they would not work if they could get away with it so surely it has nothing to do with lack of access to jobs, needing to care for ill relatives, etc
1
i'm all for requiring work if they are not elderly/disabled, and also if there are truly jobs available that they conceivably could qualify for. If there are no jobs (or they require advanced degrees which they do not have, or special skills which they cannot learn) then I see a problem. Ultimately, they are asking the doctors and hospitals to work on them, when they are contributing nothing back (Are doctors nothing more than their personal servants, while they are the kings and queens?).
3
"(Are doctors nothing more than their personal servants, while they are the kings and queens?)."
What a horrible, anti-human attitude. Or maybe it's all too human. Poor people who need help-need to give something back-because they think of themselves as "kings and queens" who are poor and sick? What?
6
The realistic and reasonable solution is to eliminate poverty to insure that no person, whether in a household or homeless, is poverty-stricken. We should redistribute the income and wealth.
Everyone, in an ongoing way, should learn how to manage their incomes responsibly, including those people with the most income and wealth and those with the least.
People who are receiving incomes in order to raise their incomes above the poverty line, and the wealthy who are not working, should, if and when they are capable of it, volunteer in their communities as their work effort for the income they receive, volunteering if there is no conventional employment for them.
It will take 3 generations for those who unfortunately are presently poor to get over the terrible ill-effects of having lived in and having been born into the poverty-stricken. There is no reason for anyone to have more money than they need to live a very healthy life in a very pleasant condition.
There is no reason for anyone to have less money than they need causing them to be living a very unhealthy life in very unpleasant conditions.
If we all can control our selfish and vain urges, ending poverty and moderating unnecessary inflation should increase motivation to develop a viable economy and living conditions for all.
Ending poverty will stimulate the economy.
4
I think what you are proposing is communism or socialism, which haven't worked very well historically (see Cuba, Venezuela, Soviet Russia). And as someone who is highly productive and is compensated for working hard, I would be disinclined to continue to work so hard if more (than now) of my earning than now were redistributed. Success and material comfort is the result of good choices and hard work, not handouts.
4
Having worked with the poor and homeless, I can tell you that one of the biggest problems is having children when you cannot afford to care for them let alone yourself. What do you do when a person who has no job, little education yet has five children. How do you prevent some or all of those five children to end up in the same predicament as their mother?
1
So, the Republicans rallied against the Affordable Care Act ranting about Democrats forming death panels when, in fact, for those not able to provide for themselves and move up to wealthy-healthy, death, disease, and shoved out of view is a deserved status from the Republican perspective of #meonly.
6
Au contraire, mon frere.
Work is healthy for people. It gives them purpose, a place to go , other people to chat with. I would assume we could see huge improvement in mental health amongst people who had purpose. I have met many a welfare mom who could not wait until most recent arrival could be sent to Headstart -- freeing Mom -- in the end the gains for the child are few altho again sometimes home is not the best place for children.
Appalachia -- been there done that. A sorry lot of people, most of whom don't have a place to go. A recovering drug addict formerly living in Portsmouth, OH, happily accepted a job nearby but NOT where her old crowd hangs ... after getting out of prison, after a drug rehab program did not work; has a second baby (first child being raised by grandparents -- does not know mom well).. (PS -right across the river from KY there.)
When one gets paid for writing OPINIONS -- where are your interviews on which you base your assumptions...
PS Many old people have diabetes 2 -- and other medical problems as a result of aging.. (who's moralizing here if one thinks it's all diet -- ever heard of DNA, RNA, genes etc.?)
BTW so far as I know no one is immortal... and some seemingly super healthy people drop dead... because of genetic abnormalities not normally tested forin a physical examination.
2
Remember, for these oligarchs, the predictable increased death rate of the poor and other "undesirables" is the point. It's a feature, not a bug.
That is because all these moralists are hiding behind their true morality--whether they can articulate it or not, they are Calvinist Social Darwinists and they think they are entitled to the resources these "undesirables" are currently using.
Calvinism, you recall, was an austere offshoot of the Protestant Reformation that opined that one is judged worthy of Heaven--one is a member of the Elect--through evidence of God's smiling providence here on earth. In effect, if one is successful here on earth, if one is prosperous and materially blessed, obviously one has been favored by God. And if one is not prosperous/materially blessed, one is obviously NOT favored by God. The logical extension: the poor do not deserve charity or compassion, as they are not worthy of heaven anyway. If they were, they'd be rich, or so the circular thinking goes.
It's not hard to see how this leads to the mentality among our "Elect" of
"if you're so smart, why aren't you rich"; "if you're not rich, it's your own fault---you're lazy/stupid/inferior, and why should I give up anything of mine for you", etc. And it's really easy to characterize those of a particular race, ethnicity, sexual orientation, nationality, etc., as unworthy, and deprive them of charity or resources, as they are not deserving of them.
Don't expect compassion from this crowd.
26
Re the headline "Making Medicaid a Tool for Moral Education May Let Some Die:" I thought that was the point.
7
I am sorry to say but far from being a bug for many Republicans this is actually a feature.
6
" MAY let some die". No, WILL. That's the entire point.
Thanks, GOP.
15
Based on many of the comments in this newspaper and others, I'm starting to doubt readers' ability to comprehend what they read.
1
The bottom line is, for Americans at large, we live in a harsh country, and it's getting harsher. The America I once knew and was raised in is gone. Each of us, whether consciously or not, has to decide if they want or can embrace this new country. Many simply can't; whatever the reasons. The author is correct. They will simply die. Very harsh, indeed.
26
By stripping the poor of birth control and health insurance, pro-life Christians hope to maintain a large steady stream of low-wage, uneducated workers in the factories and chain stores owned by pro-life Christians. That is what Jesus says Christians should do in the Gospels, isn't it?
That is the funny thing about being pro-life. Not born yet? Pro-life Christians love you. Already born. Not our problem.
38
It's hard to believe that middle-class Americans could be begrudge a tiny benefit for a family living on $400/month, but it's true. In this very newspaper I've read comment after comment from people who agree wholeheartedly with make-work benefit requirements. People who earn many, many times what these Medicare recipients live on are so resentful of the stingy help already given to the poor that they call for even harsher measures to reduce the "handouts." The hatred and jealousy of the middle-class toward the poor is absurd. People earning six-figure incomes complain because a family living on $400/month is provided medical care, or because a poor mother gets a tiny food stamp allocation. Unbelievable.
36
As a health care worker I attest to seeing able bodied men and women in their 20's, with new cell phones, gold jewelry and designer clothing on Medicaid. That's not right.
2
Agree. The WASPs understood noblesse oblige. Republicans these days on the other hand represent a vile, raw capitalistic class of people with more money than sense. It’s just a matter of time before history repeats itself and frankly, I can’t wait.
1
I'm comfortably middle class and I am happy to help people who are willing to help themselves at the same time. I gladly live in a high tax state, vote to increase my taxes for things that benefit the common good, and support a safety net and programs to help the poor. I give time and money to those less fortunate. But, I want to know what is so demeaning about healthy able-bodied people being expected to do something in return for health care, cash, or other welfare assistance? I don't mean the disabled, sick, mentally ill, very old or very young. When did hard work become demeaning and welfare become an entitlement? This is what is unbelievable.
1
Cruelty to human beings is not a side effect of modern conservatism. It is the point.
We should not be arguing about "qualifications" for access to health care. In the entire rest of the modern world of wealthy countries - that's every single country except ours - this is considered a basic human right.
Moralizing about those less fortunate than you, rather than simply helping, is itself immoral.
27
An article in the Chronicle of Higher Education yesterday nailed the real problem. The major public health crisis in our country is a lack of job training or a college education.
These are the folks largely in rural areas who claim to hate handouts anyhow and voted for Trump because he's going to give them all jobs.
Everyone knows republican policies are short-sighted and dim-witted, but I find it particularly stunning that this particular republican-championed approach to health care will likely kill off the very voters who elected this debacle of a president.
12
Don't gloss over the hugely relevant detail that these same ignorant individuals will walk over hot coals to vote for their equally despicable governors and state legislators. Matt Bevin (KY), Scott Walker (WI), Greitens (MO) are all from the same cloth - despicable.
All while ridiculously believing that Republicans are the ones who "help" them.
1
Why is the conversation about making people work for health care within a for profit system, when we should be talking about how we can make everyone pay fairly and progressively into a system that is more generous and cost efficient for all ??? ~ Single Payer
Sure if you are able bodied, then you should be working within an acceptable framework that does not indenture you ( and your family\children ) to continuously remain poor, or even go bankrupt in the process.
As usual, the press dutifully follows along in the false narative.
5
If an able-bodied adult is sponging off the US Taxpayer just because they don't want to work (and I know of some folks who fall into this category) then I have no issue with making that person learn a trade, use the trade they have (I know a welder who falls into this category), go back to school, volunteer or the horror, get a job. But the NY Times wants to make us think that we going to make disabled people work at Wal-mart to gain this benefit. There are plenty of people out there sponging off us who can work but just don't want to work. Those people should be required to get off the couch and do something productive.
6
It is explicitly stated that disabled people are exempted. What agenda are you serving with your inaccurate reading?
2
Kentucky is a state with high rates of smoking, obesity and other self-inflicted habits that are damaging to human health. The highest incidence of these lifestyle factors is among the poorest, which is the population that Medicaid is intended to help. While the new requirements may seem harsh, any policy change that can push people toward healthier choices should be given a chance.
Kentucky has 14 out of the 50 U.S. counties with the lowest life expectancy. Something needs to change.
https://en.wikipedia.org/wiki/List_of_U.S._counties_with_shortest_life_e...
4
And this policy will not improve life expectancy
Here is your nugget: “They reported suffering more days in bad health and incapacitated. And they recorded more visits to hospital emergency rooms, which are required by law to care for all comers, regardless of their ability”
Since 1986 Federal Law (EMTALA) requires the ER to assess all patients that show up, and treat as needed. Further, it is illegal to ask the patient about insurance at all. If the ER does not do this, draconian fines and even criminal charges can and have occurred for “patient abandonment”.
This has always been a completely unfunded mandate. It was overwhelming supported by Republicans and signed by Reagan.
As a surgeon involved in trauma and other emergencies, I am frequently in the ER caring for these patients over the last 34 years. People with perfectly good insurance die from lack of access or just trying to get to the ER. The ER is easily overwhelmed in times like right now while the flu is raging and hospitals close to admissions.
This policy threatens everyone regardless of insurance status. When the ER is full, get in line and hope you don’t die waiting.
14
There is nothing wrong with the idea of requiring some form of work or job training for able, unemployed people on Medicaid but, as usual, the devil is in the details.
Using the New Deal's W.P.A. and C.C.C. as models to be adapted might benefit both the aid recipients and the community at large. The important thing is that the training and work provided by the states be meaningful and accessible. The WPA built Hoover Dam, while also supporting Jackson Pollock's art. Meanwhile, many of the best structures still gracing our Parks were built by the CCC, as they employed and trained many Americans.
Yes, we must be prepared to fight for good programs, but to simply reject out of hand the idea that those receiving public aid should be exempt from providing some form of public service consonant with their physical and mental circumstances is self-defeating in the long run. Done right, programs can provide much-needed training, create public goods, and garner support from taxpayers who might otherwise oppose entitlement programs.
The author's Tennessee examples demonstrate what to avoid, not that there should be no program. Let us support state efforts to devise good programs, while fighting to make them useful and fair. Yes, they will be experiments, and some will work while others will not, but that is how we learn to improve what we do. Remember, Obamacare essentially started out as a state program instituted by a Republican governor.
To repeat, the devil is in the details.
6
"Drop dead, America !"
GOP 2018
22
Every able-bodied, able-minded adult has an obligation to contribute to society. That can be by gainful employment, taking care of children or old people, volunteer work, education, or job training (the last three cover anyone unemployed). Any of these qualifies a person for medicaid under Kentucky's proposed rule.
We have an obligation to help (including providing medical care) to the unfortunate. We have no obligation to help those who are capable of contributing to society but refuse to do so.
13
Most people want to work at living wage jobs.
6
The difference in philosophy between your point of view and mine is that I believe that the Federal government has an obligation to provide medical care for everyone irrespective of one's work history or contribution to society (just like we provide free public education because it is a common good). Is this expensive to effectuate? Yes. It will require not only the reversal of tax reductions just passed but it will also require additional tax increases and reductions in Defense Department spending. Will this make us a less economically dynamic country and potentially more vulnerable to terrorist attack? Perhaps. But the numbers of individuals killed domestically through terrorism pales in comparison to the numbers of lives lost due to inadequate medical care. There is almost a 100% chance that everyone will need affordable medical care at various points throughout their lifetimes but an almost infinitesimal likelihood that anyone will be the victim of terrorism at any point in their lives. And it also might mean a slight loss of our leadership role internationally.
But these are worthwhile trade-offs. We need to raise the floor even if that means lowering the ceiling on some economic opportunities.
But how do people with my point of view find common ground with those who have different priorities and make different judgments?
6
As yes, the old Soviet mantra (adjusted from Marx’s original): From each according to his ability, to each according to his work.
1
I have a hard time picturing the people targeted by this change. The trope that people are lazing about in the hammock of welfare just doesn't ring true for me. The other day on NPR, Gov. Bevins described Kentucky as having 200,000 unfilled jobs waiting for people to apply. I want to know where, exactly, are these jobs? Are they out at the ends of all the dirt roads in rural eastern Kentucky? Do the jobs come with their own transportation? How about childcare? The logistics of obtaining and keeping a job in rural areas can be daunting. We've already been down the road of uninsured people using the emergency department for care. It results in higher premiums for those with private insurance. The fallback position that the emergency department can't turn away people based on ability to pay isn't entirely true; all of us can get cancer, but cancer treatment is not available from an emergency department. ERs treat your urgent condition, but they don't give you chemotherapy for your cancer or physical therapy after you break you leg.
Saying that someone is unworthy of care because they don't have a job doesn't reflect our American values of justice and equality.
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I wonder how many can’t pass a drug test.
Drug testing should be illegal.
Does unpaid labor count? Laundry, cooking, cleaning, making garments, gardening, etc? Would they count the contributions so many people make to their families as work? It is work after all. Does sending the main homemaker out to volunteer really help anyone?
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I'm perfectly on board with the idea of having able bodied individuals who are recipients of Medicaid- work. Matter of fact, I think most of these recipients would love nothing more than to land a full-time job that pays them a living salary. But. That in and of itself isn't quite the problem.
The problem?
These people who are already heavily marginalized for their levels of poverty, are far too easily ripe pickings for pay and work load exploitation by potential employers. What I'd like to know is- where are the companies who will hire them and treat them with common decency but most importantly, fairness.
We are living in an age of stilted me me me capitalism where the Zuckerburgs of our time make billions- for doing very little real work. Why is hiring a poverty stricken Medicaid recipient so apparently beyond our realm of humanism.
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The elimination of the "no insurance" tax does not affect the lowest income group because they are eligible for Medicaid. Obamacare provides premium subsidies for an additional group.
If people choose not to buy health insurance, that is their choice. How does eliminating the tax on those people make the Republicans responsible for their deaths?
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"If people choose not to buy health insurance, that is their choice."
There are many things that people "choose" not to buy, as you say. More often than not, it is because they cannot afford to buy those things. Not buying some things are not really a matter of choice. Luxury items like food, clothing and shelter. And many of the people who are making these "choices" already work.
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The article concerns schemes to deny health care to unemployed people (poor people without income) who would otherwise qualify for Medicaid.
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"the odds of dying for non-elderly adults are between 3 and 41 percent higher for the uninsured than for the insured"
Is this a cause and effect relationship? The insured more likely have more well-paying safer jobs, do not smoke, exercise regularly, are not obese, do not drink heavily, and have less chronic medical problems. Insurance is an indicator of good baseline health, not the cause of increased mortality.
At the same time, Medicaid fraud remains rampant nationwide. Unmarried couples with children do not report the breadwinner's salary to the government so that the rest of the family continues to collect benefits. Wealthy and middle class families legally transfer the assets of their elderly relatives so that nursing home care is picked up by Medicaid. For every well-intentioned government program, there are numerous scams to defraud it.
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Your assertion that Medicaid fraud is "rampant nationwide" is just that, an assertion. There is no evidence of it. To the contrary there is evidence that Medicaid provides health care with great efficiency and at low cost.
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The answer is Medicare for all. Then there would be no need for “fraud “. I don’t think you understand how important health care is to people, especially families.
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Most Medicaid fraud is committed by businesses through shady billing processes. https://www.theatlantic.com/politics/archive/2013/08/just-how-wrong-is-c...
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Why the assumption that those people who do not currently qualify under these new regulations, would not qualify when they go into effect? Is the author assuming that they would not make the effort to qualify?
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"In 2005, Tennessee removed 170,000 people — almost one in 10 Medicaid beneficiaries in the state, mainly working-age adults without children — from its Medicaid program to save money. They didn’t do well."
But if these working-age adults without children--we already know the pregnant, elderly, and medically frail are exempt--are asked to work, get job training or perform community service 20 hours a week, is that a terrible thing? I don't know how to say this, exactly, but if they're healthy and they don't have kids to take care of, is making some kind of contribution 20 hours a week an unreasonable expectation?
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The poster reinforces the point of the article that the move towards work-based Medicaid is primarily a 'faith-based,' one, rather than statistical or epidemiological.
One can also be morally suspicious of practices promoted as 'not so bad,' which include, among others, waterboarding. Perhaps inquiring among those impacted by such rules would be useful qualitative information.
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Who will determine that "they're healthy" if these "healthy but unemployed people" can't see a doctor or any other health professional (on a regular basis or ever)? What will the cost be make this determination and who will pay for it?
If they were deemed "healthy" but then get sick how will they continue to work if they can't get medical care? If you give such people health care when they get sick (or preventative care so that they don't get sick) how would that be different from a system which provides health care without regard to employment status?
The ethos behind all of these schemes is that the poor and/or unemployed are in that condition because they just haven't been punished enough. It isn't the fault of landlords charging rents that can't be paid or employers providing dangerous or hazardous work conditions. It isn't because that someone has to pay for health care for the unfortunate. It is because the slaves just haven't been whipped enough.
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The problem to be addressed, though, and perhaps for another article, is really, what is available? This may be an easy solution in larger towns and cities where jobs are available, but what if they are in rural areas where there isn't anything available? I personally think the issue is the attempt to simplify the reasons people are where they are at. How do they move past this situation if the jobs they have don't even offer some health benefits in the first place? The causes and solutions are more complex than people care to acknowledge. If Kentucky saves money, will they put it towards education? Jobs? The solution must be comprehensive. Judgement Day will not be kind to those who think the solutions are simple.
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