How Medicaid Fails the Poor. Avik Roy
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Table of Contents
THE PLIGHT of American health care is best told through the eyes of a seventh-grader named Deamonte Driver.
Deamonte was born on the wrong side of the tracks, in Prince George’s County, Md. Prince George’s was founded in 1696 and was named for the Danish prince who married Queen Anne of Great Britain. In 1791, a chunk of the county was ceded to help create the District of Columbia.
Today, Prince George’s sits directly east of the nation’s capital. Aided by the decades-long expansion of federal spending, Prince George’s is now the wealthiest county in America in which the majority of the population is black. But Deamonte was not one of the wealthy ones. He was an African-American child on welfare. He was raised by a single mother. He spent his childhood in and out of homeless shelters. He died in 2007, at the age of 12.
Deamonte, however, did not die in a drive by shooting, or in a drug deal gone bad. He died of a toothache.
In September 2006, Deamonte started complaining to his mother, Alyce, that his teeth hurt. Alyce started calling around, looking for a dentist who would see him. But every dentist she called said no. Months later, after she had made several dozen phone calls, she found one.
The dentist she finally found told her that her son had six abscessed teeth, and he recommended that Deamonte see a surgeon to take them out. That took another round of phone calls. It took another several months for Alyce to find Deamonte an oral surgeon who was willing to take the job.
Within a week of the long-anticipated surgical appointment, Deamonte told his mother that his head ached. It turned out that the infection from one of his abscessed teeth had spread to his brain. Deamonte was taken to the hospital, where he underwent emergency brain surgery. He got better for a while but began to have seizures and was operated on again. Several weeks later, Deamonte was dead.
According to Ezra Klein of the Washington Post, Deamonte Driver’s story shows us why it would be immoral to repeal the Affordable Care Act, a.k.a. Obamacare, a law that strives to expand health insurance coverage to the uninsured. “To repeal the bill without another solution for the Deamonte Drivers of the world? And to do it while barely mentioning them? We’re a better country than that. Or so I like to think.”
There are many problems with Obamacare. But the law’s cruelest feature is what it will do to low-income Americans who are already struggling.
But Deamonte Driver did not die because he was uninsured. Indeed, Deamonte Driver died because he was insured – by the government. It turns out that Deamonte was on Medicaid.
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Obamacare does not offer better health care to the Deamonte Drivers of the world. Under Obamacare, if Deamonte were still alive today, he would still be stuck with the same dysfunctional Medicaid coverage that he was stuck with before. Indeed, Medicaid is likely to get much worse. According to the Congressional Budget Office, Obamacare will shove 17 million more Americans into Medicaid, the developed world’s worst health care system.
There are many problems with Obamacare. But the law’s cruelest feature is what it will do to low-income Americans who are already struggling. Study after study shows that patients on Medicaid do no better, and often worse, than those with no insurance at all.
There is a way to provide high-quality health care to the poor, one that would spend substantially less than Medicaid while ensuring that low-income Americans are protected against costly medical bills. But to understand the solution, we must first understand what went wrong.
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It may seem strange to say this, but Medicaid – a program that in 2013 cost taxpayers more than $450 billion – started out as an afterthought. In the 1930s, ’40s, and ’50s, American progressives believed that the most politically palatable way to expand government sponsorship of health care was to begin with the elderly.
After all, the elderly were a far more sympathetic group in the public’s eyes. Older Americans had less opportunity to earn their own money in order to fund their health care and were therefore generally poorer than other Americans, along with being less healthy. Being both relatively poor and relatively unhealthy, they were, in turn, also less likely to have health insurance. And policymakers believed that the model of Social Security as a “self-financed” program for the elderly, paid for with a dedicated payroll tax, could easily be extended to health insurance.
For many years, however, these efforts to expand government-sponsored health insurance were successfully opposed by a coalition in Congress of Republicans and conservative Democrats. They were also opposed by the organized force of American doctors, who feared that socialized medicine would restrict their freedom to serve their patients as they thought best.
In 1961, the American Medical Association (AMA) organized an early attempt by progressives to erect a universal, single-payer health-insurance program for the elderly. “Operation Coffee Cup,” as the AMA called it, involved asking doctors’ wives to organize coffee klatches in order to persuade their friends to write letters to Congress opposing the single-payer bill. At the meetings, the wives would play a recording narrated by an actor named Ronald Reagan, who warned that the single-payer bill “was simply an excuse to bring about what [progressives] wanted all the time: socialized medicine.” The bill was defeated.
This dynamic, in which the AMA and congressional conservatives blocked government-sponsored health care, shifted dramatically in 1964, when Barry Goldwater challenged Lyndon Johnson for the presidency.
It would have been tough for any Republican to beat LBJ that year. Johnson, John F. Kennedy’s vice president, had gained a substantial measure of sympathy after Kennedy was assassinated in November 1963. “In your heart, you know he’s right,” said a campaign ad for Goldwater the following year. But after Goldwater proclaimed that “extremism in the defense of liberty is no vice,” Johnson’s campaign retorted, “In your guts, you know he’s nuts.”
Democrats gained 36 seats in the House of Representatives – giving them an astonishing 155-seat majority – and increased their already huge Senate majority by two seats, nudging them up to a 36-seat majority. (By comparison, the substantial majorities Democrats held after the 2008 election were merely 79 seats in the House and 20 seats in the Senate.) Even taking conservative-leaning Democrats into account, liberals were utterly in control of Washington in 1965.
Suddenly, Democrats found themselves with a mandate to enact far-reaching reforms, and they did not waste the opportunity.