Most of us hope to hold on to some measure of security and dignity if life ever bottoms out. What dignity means all depends on your situation. It is better to live in a hovel than the gutter and better to stand in line at a clinic that accepts Medicaid patients than die from pneumonia in the middle of winter. For those of us who end up at the bottom, there is perhaps some dignity in government support.
Does this mean that adding to the handout rolls is something we should celebrate?
Medicaid expands, celebrates dubious achievement
Medicaid has been with us for fifty years, an anniversary not lost on the man who has grown the program beyond our wildest fears. Thanks to Obama’s Medicaid expansion, 12.8 million more Americans1 are basking in the glow of government support for their health care needs.
Working hard should mean more than a federal handout, but that’s what the White House promises:
But ultimately, we came to see these programs for what they truly are — a promise that if we work hard, and play by the rules, we’ll be rewarded with a basic measure of dignity, security, and the freedom to live our lives as we want.2
Is there freedom in being supported by the government? Federally-funded dignity and security come cheap for those who sell it (see: Dignity is Important Because It’s Cheap and Easy to Sell). What we don’t know is how many of those who receive this kind of dignity are the hard workers Obama says deserve a reward.
What about the taxpayers who pay for government-supported dignity?
Dignity from government support wastes your money
The definition of dignity implies a quality of life a bit higher than what our president is promising, but when you live by the grace of government support you have to take what you can get. We all want our fellow citizens to live with dignity, but for taxpayers the results aren’t quite as stellar as Obama makes them sound.
Is there dignity in wasting other people’s money?
The president stubbornly persists in the Democratic Party’s vision of government entitlements that never run out of cash (see: No Government Conspiracy, No Jobs, No Retirement Security). That vision usually implies massive tax increases that, so far, haven’t happened. Promising a future of generous entitlements, Democrats bide their time and wait for their numbers in Congress to change.
Barack Obama steadfastly denies any funding problems with our growing government health care programs:
Today, we’re often told that Medicare and Medicaid are in crisis. But that’s usually a political excuse to cut their funding, privatize them, or phase them out entirely — all of which would undermine their core guarantee. The truth is, these programs aren’t in crisis. 3
They may not be in crisis right now, but they do run through lots of our money and not always for the better. A just-published Government Accountability Office report found potential lapses that included 200 dead Americans receiving over $9.6 million in Medicaid benefits (read the report on the GAO website) and 8,600 recipients reaping benefits from more than one state at a cost of $18.3 million.4 Medicaid’s improper payments were $36.3 billion as of November 2016 according to PaymentAccuracy.gov. Update June 21, 2020: The Centers for Medicare and Medicaid Services published updated 2019 Medicaid improper payment figures showing $57.36 billion in improper payments and a 15.38% bad payment rate.
Spending overall is going to go up as the Medicaid rolls swell:
Each year between 2020 and 2025, about 14 million more people, on net, are projected to have coverage through Medicaid than would have had such coverage in the absence of the ACA, compared with 10 million more now.5
Americans are forced to pay into Social Security and Medicare, but Medicaid is a different beast. The Federal Government dumped $301 billion into Medicaid in 2014.6 States spent $195 billion7 and in a few short years their portion of the bill is going to increase. When you add SCOTUS-approved Obamacare subsidies and other health care spending, you get Obama’s Middle Class Economics and his 2016 budget proposal with its astounding list of tax increases and insistence on “Reversing Mindless Austerity:”8
It [2016 budget proposal] achieves these goals by replacing mindless austerity with smart reforms, paying for all new investments, and obtaining $1.8 trillion in deficit reduction primarily from health, tax, and immigration reforms.9
How can we possibly be proud of Medicaid’s expansion?
In his Medicaid anniversary celebration talk the president gave us something to be proud of:
If one of the best measures of a country is how it treats its more vulnerable citizens — seniors, the poor, the sick — then America has a lot to be proud of.10
We’ve heard that one before. What we never hear is the measure of how a country treats the money it takes in from those charged with the burden of paying for these programs. We also don’t hear how many of these citizens are really vulnerable and how many are helped down the path to vulnerability by promises of undying government support.
We shouldn’t be celebrating the expansion of Medicaid on its anniversary. With all the spending on income support, anti-poverty measures, and job creation, we should be questioning why we are still adding millions to the health care welfare rolls.
Updated April 10, 2017 to add current PaymentAccuracy.gov link.