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"Welfare Health Care"

The game of how-to-do-things-with-words continues: Minnesota Governor Tim Pawlenty has apparently started referring to the state's health care program, MinnesotaCare, as "welfare health care." With this ugly tag, he hopes to win support for cutting the program. Less than 1% of the program's participants are actually welfare recipients, however. This is a program for working people.

A former legislator who designed the program put it well: "To the extent that there is welfare at play, it is the government bailing out employers who fail to provide this essential health insurance benefit to their employees."

This is truly disgraceful. If you want to know why welfare reform was not a total disaster, it is in fact because of programs like MinnesotaCare. In the past, government health care (that is, Medicaid) was largely limited to people on public assistance. The expansion of that and other programs to cover working people made it far easier to enter the workforce without losing health coverage.

I don't see how anyone could denigrate these programs unless they had a truly pathological hatred of anything that is public, governmental, or collective. And I suppose that's the answer.

Posted by Mark Schmitt on January 28, 2005 | Permalink


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I understand that the same Minn Governor is very interested in pursuing something like Colorado's Taxpayer Bill of Rights (TABOR), which is the most restrictive set of limitations in the country and has brought Colorado's state spending levels into rough comparison with Mississippi's, despite the fact that CO is one of the 10 wealthiest states in the nation.

Posted by: paul teske | Jan 28, 2005 6:40:34 PM

what name would you adopt for giving people a service they don't earn?

Posted by: yoyo | Jan 28, 2005 10:40:36 PM


Posted by: Mark Schmitt | Jan 29, 2005 1:04:26 AM

I'm glad you wrote this: "If you want to know why welfare reform was not a total disaster, it is in fact because of programs like MinnesotaCare." I've often wondered.

In my (rural) taxi days, I used to haul a lot of folks around on Medicaid's tab, and one of them expressed best the situation many (including myself) find themselves in.

I was driving him to a neighboring city to get a set of dentures fitted. A ridiculously wasteful exercise -- in our small city, no dentists accepted Medicaid (major billing issues, anyone will tell you), and the ones in the next small city were generally sub-par (a predatory market, unfortunately). This was his sixth visit, if I recall, because the dentist had trouble getting the right fit.

The passenger had a wonderful attitude, however. He used to work, not full time, but enough to get by. But he needed insurance. He found that his employer's plan costed more than he was earning. (Individual insurance costed $450/mo. in that county last I checked, by law no matter what your conditions. The employer he named didn't sound generous.) So he quit, and got on Medicaid. Simple!

Smart man -- stupid government.

P.S. Now that you are at a futurist think tank, what's the next step? (Assuming most of us survive the next term under some kind of "health savings account.") HillaryCare? Health insurance vouchers?

Posted by: Ezra | Jan 29, 2005 2:10:35 AM

Nice coverage. The real culprit in out-of-sight medical costs is the insurance industry. Where else do you find individuals who work for a living (MDs) covered by a plan to pay for their labors. I turely wonder how the world would run if we had plumbing insurance, grocery insurance, butcher insurance, or even, gas station insurance. All of this after the MD has a great deal of federal subsidy in his educational efforts. Why should any craftsperson have their incomes covered by prepaid income guarentees? I wonder what a MD visit would cost if there were no pre-scheduled procedural categories. S.

Posted by: sesdvs | Jan 29, 2005 9:47:52 AM

If you have a stupid system, you will get stupid results.

Posted by: ying-yang | Jan 29, 2005 10:02:12 AM

what name would you adopt for giving people a service they don't earn?

basic human decency?

Posted by: Don Quijote | Jan 29, 2005 11:21:18 AM

Oh, lordy. "Welfare care?" Most people on Medicaid are poor women and kids, a lot of whom work (the women, obviously). Throw a rock in a Wal-Mart, you're going to hit an employee who's on Medicaid. Medicaid is unbelievably cost-effective for this crowd, paying for immunizations, checkups and antibiotics for ear infections so little poor kids don't end up deaf.

However, a smaller percentage of the people on Medicaid are elderly and/or disabled. A lot of these folks, especially in states like New York, are middle class people who qualify for Medicaid by giving all their assets to their kids and becoming "poor."

So, um, if you want to save money on Medicaid, you can knock every mother and child off the rolls, but you're not going to save much and you're going to pay for it down the road anyway. Saving money on Medicaid means pulling grandmothers off ventilators, and telling parents that if their kid with Down's Syndrome needs bypass surgery, they're going to have to find a way to pay for it.

There are definitely ways to save money on healthcare, but those are hard fixes that involve changing the entire system. If you just want to cut the Medicaid bottom line, there is no way to do it without denying sick people medical care. All this "welfare insurance" talk is a lying attept to obscure that reality. But that's the reality.

Posted by: theorajones | Jan 29, 2005 11:34:45 AM

The answer is, MD's would earn a lot more, and healthcare would cost a lot less, as there would be no beauracracy to subsidize.

Posted by: Dan | Jan 29, 2005 4:13:52 PM

Um, bureaucracy.

Posted by: Dan | Jan 29, 2005 4:15:22 PM

All the talk from the right-wingers about their's being the party of "moral values" makes me want to puke. A society that doesn't care for its least fortunate with some kind of basic guaranteed health care program, is an immoral society. That, right-wingers, is a real "moral value".

Posted by: badgervan | Jan 29, 2005 11:42:24 PM

If some judge decided that your automobile insurance should also cover gas and lube jobs, would your premiums go up? Kinda like when workman's compensation was forced to cover normal pregnancy.

Posted by: Walter E. Wallis | Jan 30, 2005 12:17:14 AM

Lots of our problems could be solved if we had better wages and salaries. America is a low wage country, the employers can't compete if they would have to pay for health care,vacation,paid maternity leave,taxes,unemployment insurance and so on. Why can't they compete in world markets anyway?

Posted by: RAB | Jan 30, 2005 12:21:12 AM

"Colorado's state spending levels into rough comparison with Mississippi's, despite the fact that CO is one of the 10 wealthiest states in the nation."

Mississippi and Alabama are the models republicans want for the whole country: an ignorant masses, pliant to do whatever the plutocracy desires.

Posted by: sheet | Jan 30, 2005 1:12:30 AM

Isn't it a bit absurd comparing auto insurance with health insurance? Auto insurance is mandatory in my state - but health insurance is not. Further, driving a car is considered a privilege, not a right. Is basic health care a privilege only for those who can afford insurance?

Cold, man...really cold.

Posted by: Bhaal | Jan 30, 2005 7:39:31 AM

Gov. Pawlenty, what would Jesus do?

Posted by: Chief Pilot | Jan 30, 2005 7:50:18 AM

This summer, my daughter spend 3 weeks in Germany. She fell and cut her hand, and needed stitches. She had a followup visit and a stiches removal visit.

In this country, a trip to the ER costs, min, $500.

In Germany, they paid EE 35. That's roughly 1/10.

Of course, I don't know what the real cost is.

In this country, I recently had a trip to the ER for myself for vertigo. The insurance company has refused to cover the ambulance, saying that the ambulance is not a network provider. Think about that.

I work in the health care system. This system is terrible. We need single payer national health care.

Posted by: POed Lib | Jan 30, 2005 8:24:36 AM

I live in England, where we have a reasonably functioning system which provides for everyone, based on public taxation. It has its downsides and major problems, but it does mean those without adequate income always get treatment. I find the American situation, and attitude to taxes which pay for this sort of thing on the part of the Right, morally repugnant. This is not a general condemnation of American society (spare me the usual Right wing rants if you would).

Posted by: Andrew Bowie | Jan 30, 2005 9:04:56 AM

Both the GAO, headed by a Bush appointee, and the CBO have found that Medicaid has far less overhead than insurance companies add to medical care. Government health programs in other countries also have lower administrative costs. Whether it's due to economies of scale of government, or advertising costs of and rate gouging by insurers, or because insurance companies are also bureaucracies, the most authoritative sources around say you have it absolutely backwards.

Recalculate your conclusions, please.

Posted by: rowrbazzle | Jan 30, 2005 9:22:59 AM

"Gov. Pawlenty, what would Jesus do?"

He would die young from a preventable disease, of course.

Posted by: OmerosPeanut | Jan 30, 2005 12:48:16 PM

"Welfare" is only an "ugly tag" in the USA, so far as I know. In more civilized countries, the government's duty to provide for general welfare is taken more seriously.

Posted by: Grumpy | Jan 30, 2005 1:11:02 PM

The term welfare society seems a pejorative unless you realize that what it really means is that the society takes care of its welfare, including that of those who cannot afford all the modern human necessities. A society that takes care of its welfare is a secure society that only needs to fear the societies outside that do not, such as the barbaric United States which tries to makes its citizens afraid of the whole world to divert their attention from the fact that the US society is imploding from its own atomism.

Posted by: | Jan 30, 2005 6:39:07 PM

Why do Republicans do everything to stop eliminating poverty? Are they proud of the level of poverty we have in the US? They would look so much better if they showed a little generosity, just sometimes. They must like a dog eat dog world.

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