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Morally and Fiscally Responsible Health Care Policy

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Benjamin Kalinkowitz
March 19, 2018

Fifty-four years ago, President Johnson declared an unconditional war on poverty, arguing that the richest country on earth could and should invest in improving the infrastructure necessary to make it possible for all Americans to achieve financial security. In the years since, the policy conversation has shifted; now, you’re more likely to hear about fraudulent use of benefits and attempts to ensure that that government welfare programs only benefit those who “deserve” them. Most recently, discussion has turned to replacing food stamps with a monthly box of mystery food and putting work requirements and lifetime caps on Medicaid, turning the war on poverty into a war on the poor. This is painfully misguided. Not only do these policies dehumanize those in need, but also, they spend taxpayer dollars without significantly improving American life.

Echoes of the lazy welfare queen remain in the rhetoric of American politics despite being soundly disproven. Research has shown that children born into poverty are not only at an educational disadvantage before they start school, but also then attend chronically overcrowded and underfunded schools. When these children enter the workforce, they face a job market with few opportunities that offer career advancement. Minimum wage jobs fail to allow someone working a full 40 hour work week to squeak by, let alone get ahead. While our national narrative praises the “self-made man” who “pulled themselves up by their boot straps,” what we ask of impoverished Americans is to climb Mount Everest without any gear or training. It’s no wonder that few make it.

But rather than using the existing social welfare framework to improve the lives of those who struggle the most, American anti-poverty money is too often squandered on politically expedient but unhelpful programs. Despite the billions of dollars spent to maintain a safety net, a recent UN report on poverty in the United States has shown that America’s welfare money is frequently misallocated. Too often, “welfare reform” just results in the same level of spending with worse outcomes. However, when the government chooses to spend money on meeting basic needs, those dollars are reinvested back into the economy, allowing beneficiaries to successfully start to climb the economic ladder. Medicaid expansion is one successful example: while there was initial concern that it would increase the burden on already swamped ERs, wider coverage has resulted in an overall decrease in ER utilization, freeing up ER beds for those who truly need emergency care. Additionally, expanded Medicaid coverage ensures ER bills are being paid by insurance, rather than forcing states to cover uncompensated care directly. And not only hospitals are benefitting– health outcomes for poorer Americans in Medicaid expansion states started improving, especially when compared to non-expansion states. While funding Medicaid is not free, it improved hospital balance sheets, while simultaneously improving health outcomes, and creating millions of jobs. Using taxpayer money to meet the basic needs of those in poverty, “worthy” or “not,” is ultimately a financial boon.

Discussing whether an individual deserves help misses the main point: both doing something and doing nothing carry a cost. The government can spend money subsidizing hospitals for uncompensated care or can subsidize individual health coverage. Government can mandate that a minimum wage is a living wage, allowing people to earn the necessary funds to support themselves, or inevitably subsidize government run housing and food programs. Fiscally sound policy should insure that taxpayer dollars spent benefit the public good and should ultimately provide a return on investment. Expanding Medicaid is helping keep hospitals financially solvent, improves health outcomes and creates jobs. Rather than looking for ways to limit access, it is time to act on the fact that increasing healthcare access for all makes both moral and fiscal sense.


Author: Benjamin Kalinkowitz, PT, DPT, MPA earned his Masters in Physical Therapy from Hunter College-CUNY, his Doctorate in Physical Therapy from the University of Kansas, and his MPA from the University of Nebraska at Omaha. Dr. Kalinkowitz has been a practicing physical therapist for over 10 years, having spent 8 years working at the Department of Veterans Affairs, and currently in practice at a hospital based outpatient clinic in New Jersey. All views expressed are the author’s alone, and do not necessarily represent the views of his current or former employers. Email: [email protected] Twitter @BenKalinkowitz

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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