Workin’ it

Work leads to money, and to the good things in life likeworkin_hard

  • BMWs
  • Chocolate bonbons
  • Warm socks
  • Medicaid coverage

Wait, Medicaid coverage??  Yes, at least 10 states are pursuing a new rule that will require certain people to hold down a job or do volunteer work in order to get Medicaid coverage.   The problem with the debate about this is that both sides are exaggerating their “facts”. 

The pro side says it will, in the words of Kentucky governor Matt Bevin, give people “a path forward and upward” out of poverty.  Others chime in and say it will teach people the value of working, even if they do volunteer work.  Really?  The money-is-nice-to-have message is not already effectively delivered every minute of every day to every low-income person?

It’s also unclear how the Medicaid requirement will light up a pathway from poverty to plenty.  Think of all the other things that require a person to work or somehow gather money – eating food comes to mind, and people need to do that every day.  Medical care is not an every day, every few hours kind of thing – why would medical care be more inspiring than food?  (Yes, some families get food stamps, which are deliberately designed to provide insufficient food.  That’s why it’s called Supplemental Nutrition Assistance Program.)

The con side says it will kill people by delaying care.  This is a distortion of correlation and causation.  A New York Times article mentions that women who live in low-income zip codes are more likely to get a diagnosis of late stage cancer than women in high-income zip codes, who get their cancers diagnosed at earlier stages.  This is absolutely true (though the difference is not huge), but the reason for this disparity has more to do with the realities of poverty, rather than to the presence or absence of health insurance.

The demands of poverty shrink a person’s frame of mind to the overwhelming present demands.  Finding food for dinner is a much higher priority for a woman than getting a test for something that she may or may not have, an illness that has given her no symptoms.

So the con side is wrong that having health insurance will improve a person’s health.  It won’t.  There are hundreds of other things, much more pressing, that shape a person’s health status; preventive care is the least of them.

The pro side is also wrong about a Medicaid work requirement leading people out of poverty.  There is no shortage of deprivations for poor people.  We surely do not need to create a new one.

Bottom line, no one is going to rise out of poverty because Medicaid put on a new rule.  On the other hand, the loss of Medicaid is only one of a hundred factors that shorten lifespans for people in poverty.  We would all be better off to focus on meeting social needs, instead of fighting over who deserves to have these needs met.

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