"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." You should recognize that line, it's the one famously penned by Thomas Jefferson and is found in the preamble to the Declaration of Independence. One could argue that a lot of Rights listed as guaranteed by our Founding Fathers still have not come to fruition, but one that I feel has gone most glaringly unfulfilled is the Right to Life. That's right, if you do not have the means to obtain medical care in this country it's your problem, tough luck, don't expect the government to help you, start digging your grave. Well that's the views of some in this country anyway. The current philosophy of healthcare in America is that it is a privilege, not a right.
I've worked in the medical field my entire career and went into medicine because I felt that it was a calling for me to play at least a small part in improving the quality of life for others. Even though I've transitioned from the clinical environment to the corporate one my goal has always been to contribute to helping others and my conviction is that everybody has a right to receive care regardless of their station in life. Unfortunately there are some in this country who do not share my views, in fact there are enough people in this country who view healthcare as a privilege that even in 2011 the United States remains the only large western nation without universal healthcare. I suppose something that's good enough for the rest of the developed world isn't quite good enough for us Americans. I could write an entire book about the attack on healthcare in this country, but I'm going to break-up this broad topic into multiple parts with this first part covering the much attacked and much misunderstood program called Medicaid.
Recent events in the US House, Florida, and New Jersey have motivated me to finally write a blog discussing Medicaid. Earlier this year the Florida Senate proposed cutting Medicaid by more than $1 billion and Gov. Christie of New Jersey is lowering the maximum qualifying income level of Medicaid recipients from from the current $24,645 to the ludicrously low $5,317. Of course who can forget the House GOP budget proposal that would cut federal Medicaid contributions to states. I think all of this begs the question, what's so bad about Medicaid? First let us get a better understanding of what Medicaid is and who it helps.
Medicaid is a healthcare program offered cooperatively by the federal and state governments to the disabled, children of low-income families, and older Americans requiring nursing home care (along with a few other categories). The predominant misconception about Medicaid is that it is for the poor, critics infer that the "poor" are freeloaders who are scamming the system. Having a low income alone does not qualify a person for Medicaid, it is a combination of low income paired with falling into certain eligibility groups such as those listed above.
According to the Social Security Administration (SSA) children of low-income families make up 53% of all Medicaid recipients. That's worth repeating, children make up 53% of all Medicaid recipients, just think about that the next time you hear someone decrying Medicaid and championing huge cuts to it. The disabled make up 16% of Medicaid recipients, these are people who may not be able to work or who do not have the capacity (mental or physical) to live on their own and require nursing home care or live in group homes. So more than two-thirds of Medicaid recipients are children and the disabled. The SSA goes on to say that 41% of Medicaid funds went to nursing home care in 2008.
One of the primary arguments against Medicaid is that people scam the system, but it is quite difficult to scam Medicaid as there isn't any financial benefit to do so, you do not receive any type of direct payment from the Medicaid program, any payments from the program are made directly to the medical provider. Let us remember that one of the requirements to be eligible for Medicaid is low-income (again, not the sole requirement) and you have to prove your income level to the government thus demonstrating that you cannot afford private insurance. So it's not folks who just don't want to purchase health insurance, those are primarily recent college grads, it's those who cannot afford insurance for their children or because they're disabled and cannot work to earn enough for private insurance. Another argument for cutting Medicaid is cost but the problem is that there really isn't much to cut. I'm sure that there is some level of waste in the program as there is in most programs, but I would venture to guess that waste is minimal and that most dollars are going directly to care. What is really driving up the cost of Medicaid are healthcare costs that are driven up by private insurance, that is the source of the problem and cutting Medicaid funding to cash-strapped states will not help the bottom line and in fact would probably cost the government more money. Again 41% of Medicaid funds go to nursing home care, how much more would it cost the government when patients can no longer stay in nursing homes after Medicaid is cut and have to live out the rest of their lives in a hospital instead? Or how about the children who make up 53% of Medicaid recipients, if they get cut how much more will it cost the government when they no longer have access to preventative care and make a trip to the ER each time they get sick and stick the taxpayers with the bill?
So if Medicaid actually goes to people who truly need it and if you can't really scam Medicaid and it would probably cost the government more in healthcare dollars to cut Medicaid then why propose cutting it? Because the recipients of Medicaid are easy targets. As we've seen two-thirds of Medicaid recipients are children and the disabled, throw in the aged in nursing homes (another 8%) and you have a group of people who can't vote, people who essentially don't have a voice. An America where we throw our children, disabled, and elderly under the bus in an effort to save (not really) the government a few bucks is not the America our founding fathers envisioned. They were serious about that right-to-life thing and private insurance has been very successful in convincing us that Medicaid, and more broadly universal healthcare, is something we don't want. It's time for us to pull our head out of the sand, do some reflection about or morals and priorities and finally stand up and speak for those who cannot speak for themselves. We must defend Medicaid.
For more information on Medicaid check out the Centers for Medicare and Medicaid Services (CMS) website.
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