Tag Archives: Medicaid

A foolish consistency*

Here is an extreme libertarian type (wrongly identified, I think, as a Tea Party type by Gawker, etc.), Greg Collett, father of 10, from Utah, going all Ayn Rand on social programs he makes use of.  Which is to say: “I’m against Medicaid, but I use it for financial reasons” (or something, because he doesn’t really say why).  He writes:

The vast majority of the comments directed towards me try to paint me as a hypocrite for being a limited government advocate and having my kids on Medicaid. My political beliefs are certainly not popular, and in this case, there are many people in the liberty movement who want to take me to task. Again, we are dealing with a situation where people have been socialized into believing a lie.

Let me set the record straight. Yes, I participate in government programs of which I adamantly oppose. Many of them, actually. Am I a hypocrite for participating in programs that I oppose? If it was that simple, and if participation demonstrated support, then of course. But, my reason for participation in government programs often is not directly related to that issue in and of itself, and it certainly does not demonstrate support. For instance, I participate in government programs in order to stay out of the courts, or jail, so that I can take care of my family; other things I do to avoid fines or for other financial reasons; and some are simply because it is the only practical choice. With each situation, I have to evaluate the consequences of participating or not participating.

Collett is a kind of anti-government purist (all government taking is theft, essentially).  He doesn’t personally carry health insurance, but he uses government programs (Medicaid but not public schools–you really have to read the manifesto) to cover his children.  Children are expensive, sickness is expensive and can be financially devastating.  His choice of Medicaid to cover his children  (as well as his choice of becoming a foster parent to eight children) demonstrates that perhaps his insistence that government leave this role is not actually feasible.  It’s nice, in other words, to have ideals, but seriously, they have to be practical.

And this is a critical point about non-fallacious tu quoques.  They do not demonstrate that your beliefs are false.  They demonstrate that your beliefs may be too hard to put into practice if not even you, ardent exponent of milking your own cows, cannot do it.

*Here’s the rest of the Emerson passage (from “Self Reliance”):

 A foolish consistency is the hobgoblin of little minds, adored  by little statesmen and philosophers and divines. With consistency a  great soul has simply nothing to do. He may as well concern himself  with his shadow on the wall. Speak what you think now in hard words,  and to-morrow speak what to-morrow thinks in hard words again, though  it contradict every thing you said to-day. — ‘Ah, so you shall be  sure to be misunderstood.’ — Is it so bad, then, to be  misunderstood? Pythagoras was misunderstood, and Socrates, and  Jesus, and Luther, and Copernicus, and Galileo, and Newton, and every  pure and wise spirit that ever took flesh. To be great is to be  misunderstood.

You’re on your own

It wasn't long ago that George Will called Obama's very catchy "you're on your own" line (from his acceptance speech) a straw man of the (discredited) Republican philosophy of government.  So I was struck when I read this encomium to being on one's own (creepy lines in bold).

When Medicare was created in 1965, America's median age was 28.4; now it is 36.6. The elderly are more numerous, and medicine is more broadly competent than was then anticipated. Leavitt says that Medicare's "big three" hospital procedure expenses today are hip and knee replacements and cardiovascular operations with stents, which were not on medicine's menu in 1965.

After being elected to three terms as Utah's governor, but before coming to HHS, Leavitt headed the Environmental Protection Agency. He came to consider it a public health agency because the surge in Americans' longevity in the last third of the 20th century correlated with cleaner air and fewer waterborne diseases. Longevity is, however, expensive, and demography is compounding the problem.

In the 43 years since America decided that health care for the elderly would be paid for by people still working, the ratio of workers to seniors has steadily declined. And the number of seniors living long enough to have five or more chronic conditions — 23 percent of Medicare beneficiaries — has increased. Many of those conditions could be prevented or managed by better decisions about eating, exercising and smoking. The 20 percent of Americans who still smoke are a much larger percentage of the 23 percent who consume 67 percent of Medicare spending. Furthermore, nearly 30 percent of Medicare spending pays for care in the final year of patients' lives.

If only we could find some kind of completely tone-deaf market analogy for how medicare should work:

Suppose, says Leavitt, buying a car were like getting a knee operation. The dealer would say he does not know the final cumulative price, so just select a car and begin using it. Then a blizzard of bills would begin to arrive — from the chassis manufacturer, the steering-wheel manufacturer, the seat and paint manufacturers. The dealership would charge for the time the car spent there, and a separate charge would cover the salesperson's time.

Leavitt says that until health-care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system: "In the auto industry, if the steering-wheel maker charges an exorbitant price, the car company finds a more competitive supplier. In health care, if the medical equipment supplier charges an exorbitant price, none of the other medical participants care."

The auto industry?  The one with the huge bailout?  Anyway, back to the ice floe:

Rather than ruining the new year by dwelling on Medicare's unfunded liabilities of about $34 trillion (over a 75-year span), ruin it with this fact: In the next 50 years, Medicaid, the program for the poor — broadly, sometimes very broadly defined — could become a bigger threat than Medicare to the nation's prosperity.

This is partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard — sometimes as high as income under 200 percent of the federal poverty level. And many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use "income disregards" to make poverty an elastic concept. For example, they say: A person who gets a raise that eliminates his eligibility can disregard the portion of his income that pays for housing or transportation.

Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free.

Indigent elderly, since you're a threat to our nation's prosperity, "you're on your own."