Kevin Drum is suspicious about the Iowa Medicaid deal that Richard posted about yesterday:
Hmmm. Iowa’s waiver application doesn’t describe this wellness program (a draft protocol will be submitted next March), but it does provide a hint about its goals:
The state shall submit for approval a draft section of the protocol related to year 1 Healthy Behavior Incentives including, at a minimum….the health risk assessment used to identify unhealthy behaviors such as alcohol abuse, substance use disorders, tobacco use, obesity, and deficiencies in immunization status.
A single person at 50 percent of the poverty line makes less than $500 per month. That’s obviously not someone who can afford even a nickel in extra expenses. But that was the income level in Iowa’s initial application, which means that for all practical purposes the original goal of this program was to (a) deny government benefits to poor people who are smokers, drinkers, drug users, or overweight, but (b) provide the benefits if these poor people agree to fairly intrusive government monitoring that ensures they improve these behaviors.
Kevin’s probably right that the Iowa Republicans want to at least give the impression that the poors are going to be appropriately shamed and probed to get their Medicaid, but my guess is that it will be just that: an impression. If someone is, say, obese and diabetic, it is the height of stupidity to deny them relatively inexpensive ongoing care that can be provided by mid-level providers in a clinic, using generic meds. The alternative is multiple crisis trips to the Emergency Department that probably cost a couple of orders of magnitude more than regular preventative care. I realize that we’re dealing with Steve King-level idiocy here, but I doubt HHS will sign off on shit like that.
That said, you know what might incent someone who makes less than $500/month to attend wellness classes or lose weight? Hint: it has pictures of dead Presidents on it and is legal tender for all debts, public and private. There are commercial insurance plans that pay people for (remarkably ill-defined, in my experience) wellness efforts. There’s no reason that we couldn’t give a progam like that a shot with this population, other than the constant need to remind the poors that they are moochers and looters. So, of course, it will never happen.
Well now that everyone should have health care, emergency rooms should be able to deny anyone who doesn’t.
Economics of the poors is always a morality play. They lost and the dispassionate invisible hand has spoken.
For that matter, pictures of dead Presidents can help the poor person buy healthy food instead of whatever is on the dollar menu.
If someone is, say, obese and diabetic, it is the height of stupidity to deny them relatively inexpensive ongoing care that can be provided by mid-level providers in a clinic, using generic meds.
Height of stupidity, you say? Let me remind you that one of the central tenets of modern conservatism is that the poor (especially poor minorities) MUST be punished for being poor, no matter what the costs might be.
In the eyes of conservatives, an obese and diabetic person is clearly of morally inferior character and thus deserving of misery. Treating those conditions goes against the will of God.
Rob in CT
Moral hazard something something.
@Derelict: If medical treatments could just be more painful and agonizing, would conservatives support spending on it?
Perhaps we could turn this frown upside down and let John Yoo amend the Hippocratic Oath.
In the science fiction part of my mind, a mysterious “Rapture” vanishes such folks….. leaving the majority of conservative voters to find those slots gaping open… and themselves being pressed into service.
Because they have to find someone to feel superior to, and to torment. Have to.
The poor people are translated straight into heaven? Cool! And all conservatives are Left Behind? Double cool!
Nunca el Jefe
@WereBear:in the revenge fantasy part of my brain (full disclosure: I just watched kick ass 2, which plays a role in this), there is nothing mysterious about what disappears those folks.
Nunca el Jefe
@Nunca el Jefe:uhhhhh, those folks being the conservatives pushing these things, just to be clear. LF read you correctly
You just pointed out that the Republicans are absolutely going to do it.
Ken Cuccinelli proposed changing the law so emergency rooms would only be required to provide care to people who are really sick. I’m sure he’s not the only one.
Making sure some (brown) person somewhere isn’t getting something they don’t deserve, regardless of the harm to everyone else, is one of the highest tenets of conservatism. Nose, face; you know the drill.
Trying out a program to give poor people cash for improving their health through preventative means would seem to have Michael Bloomberg and the Gates Foundation and Warren Buffett written all over it.
They can write checks. It’s in the public interest. You could start with one state, or two. Limited geography and scope.
If it works, and is cost effective (as is likely), you’ve got your demonstration project.
It would be refreshing to see billionaires spending on poor people in this country, in a carefully planned and evaluated trial program, vs. the more usual Koch Brothers throwing around cash to end of functional democracy.
Stupid is as stupid does.
This is just another way for those with the means to demean the poor by forcing them to adhere to standards which they, themselves, reserve the liberty to blow off as they see fit.
Eventually, maybe we could see a tax on cheap fast food that goes straight to funding preventative care for low income populations; even providing them fresh, affordable food. (Alleviate those food deserts.)
No one can seriously argue proximity to McDonald’s food is making people healthier. Filling their bellies cheaply in the short run, maybe.
It is startling to look at news footage of the 1960s and 1950s. People had different body types. It’s right there.
ETA: if not a tax on the food, which consumer pays, a tax on McD’s and other fast food chains. Something along the lines of tobacco. McD’s, and its owners hoovering up money while fattening and sickening the public, is wrong.
This is so frustrating. In the real world, health care helps poor families to become more stable by keeping them healthy so they can work, go to school, and support themselves.
Alan Grayson was correct when he gave the speech about the Republican Health Care. Of course, MSM was just shocked.
At least Iowa is doing something. As much as the requirements are painful, at least another 150K are going to get insurance. Here in Texas, they’d love to end Medicaid without having to pay for anyone.
@Elizabelle: Yes, a soda and fat tax could go directly to funding clinics in poor areas.
@aimai: Oh, hell, lets include a beer, wine, and yacht tax to do it.
Or maybe we could raise the minimum wage to something that would let even poor people afford better food and transportation to get them to where it’s sold. And a pony.
Agreed that HHS would be stupid to sign off on that, but I can see why republicans would like it. Republicans despise anything resembling progressivity because it undermines the notion that economic success has more to do with virtue than market power and social position. They figure the cost of the emergency care comes more from insurance rate payers than from progressive taxation. In other words, this system provides a backdoor healthcare flat tax, which the GOP loves even though it is inefficient. Using the emergency room as a healthcare provider of last resort is a feature, not a bug. The added benefit is the punishment involved in going to the emergency room, e.g., having to wait in line.
We could do both. Minimum wage and tax on fast food providers. Both ideas are coming into their time.
The pony? Have to get back to you on that one.
PS: I think we should have a special Wal-Mart tax too, that funds health and welfare in Wal-Mart’s community.
Wal-Mart and McD’s are predator capitalists that provide inferior products and suck money right out of the local economy and into the owners’ coffers. Cheap goods and poor health in their wake.d
They do have armies of lobbyists who say they’re just businesses that employ people.
But they’re business models that are destructive to our greater good. Start now.
I think this is the most inexplicable, unfathomable, and yet commonplace part of the conservative attitude. My brother thinks this way. He isn’t a mean-spirited guy, not at all. And I don’t think it’s consciously about “brown” people as opposed to other undeserving people – poor white people living in Appalachian trailers should also get nothing they don’t deserve, as far as he’s concerned, but like most conservatives he thinks first about the browns and blacks when he thinks about the undeserving moochers.
We had a long conversation once about “illegals” (his word) getting emergency medical care and driving up the cost for everybody. He admitted that the alternative – to allow human beings to die in the street – was unacceptable. He admitted that universal coverage would significantly mitigate the supposed problem. He admitted that “illegals” do in fact pay taxes, that Mexicans work hard at unpleasant jobs, that they are mostly here for a better life for their children and that’s actually admirable. He had all of the basic facts right – but he still drew the counterfactual conclusion, that “illegals” should be turned away from hospitals and that “Obamacare” is a terrible thing because it leads to socialized medicine. People shouldn’t get what they don’t “deserve,” regardless of the cost to society and to individuals.
How do you get through to people who understand the basic facts, agree that letting people die in the streets is unacceptable, but still refuse to countenance people “getting something for nothing?”
My dad was just saying the other day that the county commissioners should assess some sort of charge or user tax for each Walmart employee to offset the services their employees use.
Corbett’s got a similar semi-Medicaid on file with HHS, too, funneling it through health insurance companies. All recipients have to participate in a “wellness” program and, if they’re not working more than 20 hours/week, a job search program.
One good thing about this proposed program is its boost to employment: all those people to devise these programs, present them on an ongoing basis, and keep track of everyone to make sure they’re doing what they should be doing. More jobs than fracking! (Although nowhere near as much money for Corbett as the frackers.)
I have had limited success with explaining that we pay now but we don’t get good value for our money. I think the average family pays something like 1,000-1,200 (1,800 in Texas because of the volume of uninsured) in higher premiums and health care costs because providers increase their rates to cover the uncompensated care they currently provide mostly in the ER.
I try to tell people that we will get better outcomes and help struggling families stabilize and be able to work and go to school and become contributors.
Someone here posted a New Yorker (I think) article about a doctor who came up with a plan to take care of the “hard cases,” aka the people with multiple health problems who are repeatedly admitted to the hospital and use up a huge proportion of healthcare money. Does anyone have that link? He was able to get really good results by essentially setting up specialty clinics where each person had a team assigned to them to coordinate their care. It cost money up-front, but sharply reduced costs overall.
I think it has to be put in purely selfish terms. People like this truly don’t care about other people, especially poor or brown or black people, and in fact it’s counterproductive to argue explicitly for policies that will alleviate those problems on the basis of helping those less well off. They despise the less well off.
You have to explain it in terms that will directly benefit the person you are trying to convince.
I think that’s what makes the newest version of minimum wage arguments more effective. We are pointing out that Walmart and McDonalds are foisting their expenses off onto the taxpayer in the form of medicaid, snap and other programs that WE HAVE TO PAY FOR out of OUR taxes.
We are enriching the already fabulously rich Walton Family and the greed soaked bastards on Wall Street with our tax dollars, because we have to pick up the slack for the wages they won’t pay. (And it would be lovely to bring the argument full circle by pointing out that, adding insult to injury, our tax policies greatly favor the Walton’s unearned income over our earned income)
Yep. We’re paying for healthcare for those workers no matter what, so would you rather pay for it out of your taxes, or would you rather pay an extra 25 cents for that Big Mac?
I’ve been thinking (not seriously) of running for local office here in my reliably republican town, where repubs outnumber dems by about 3:1, on a platform that promises to lower their taxes AND increase funding for our schools.
What I won’t say too loud is that I plan to do it by raising taxes by some huge amount on the relatively few but super uberwealthy people who live here with a graduated unearned income tax.
Or maybe I would even tout the UNearned part, in a subtle class war pitch, although I think people here revere their “landed gentry” betters, so that might not fly
Yes, yes, I know it’s not really feasible –among other things I don’t think we can legally institute an unearned income tax – only working wages can be taxed, don’t ya know!
Still, I think it could be a winning strategy. “I’m going to lower your taxes! And free ponies for everyone!”
Better yet, don’t pay for it out of your taxes AND you don’t have to eat their shitty food!
Sounds like Republican death panels to me.
Yeah, and what happens to the big box once Wal-Mart (or another mega-retailer) moves a few miles up the road?
It’s expensive to get your green rolling fields back.
You have the right to food money
Providing of course you
Don’t mind a little
And if you cross your fingers
@MomSense: Also, as DPM pointed out the other day, one should think about the children involved. Even if a person thinks that the adults don’t deserve help, he or she should be able to admit that the children should not go without food or medical care. A child is the innocent victim and the most vulnerable. I look people in the eye and ask, “Do you seriously want an innocent child to suffer because of your resentment of their parents?” Conservatives find it very difficult to answer that question when it is asked plainly.
“Always stick, never carrot” is just right.
Conservatives seem to like to force people into programs they are unwilling to pay for, if they were voluntary.
For instance, this program is going to force people into drug treatment programs, when in most localities VOLUNTARY drug treatment programs have years-long waiting lists.
So I’m willing to compromise: if the GOP is willing to pay for it, I’m willing to make it compulsory, as that seems to give the GOPers their needed fix of poors-shaming. It’s stupid, but we are a stupid country.
This reminds me of another similar case: remember when some years ago a mentally ill man pushed a young woman under a subway train in NYC?
It came out that the guy had BEGGED to be admitted for hospital treatment, but was refused because the state had cut funds for mental health.
And what was the (GOP) governor’s solution? He got a law passed that would force INVOLUNTARY commitments!
I guess we should encourage poor people in GOP states to go on TV and REFUSE to go on Medicaid, so then GOP governors can force them to take it.
It may be the only way.