In an age when we are supposed to be a society that cares enough to see that all of us receive the health care that we need, we still have among us those who insist that people with no assets — often homeless and frequently missing meals — are supposed to exercise “personal responsibility” by paying funds that they don’t have as a condition for receiving essential medical and mental health care.
It is completely irrational and inhumane to have consumer-directed, moral hazard-based policies that erect financial barriers to care for the four-fifths of the U.S. population with minimal or modest resources.
Former New York Times columnist Bob Herbert wrote,”We abandoned the fight against poverty and it’s been growing like an infection in an untreated wound. It’s as much of a disgrace as it was in President Kennedy’s era but the willingness of mainstream politicians to speak out candidly and forcefully against it seems as old-fashioned as carbon paper and rotary phones. America should be ashamed.
Nearly 50 million people in this country, the richest in the world, are poor. Another 50 million, the near-poor, are just a notch or two above the official poverty line. They can feel the awful flames of poverty licking at their heels. Those two groups, the poor and the near-poor, make up nearly one-third of the entire American population
And what are our mainstream politicians doing? When they’re not hammering the poor, mocking them, waging war on the threadbare safety net programs that help stave off destitution, they’re running as fast as they can away from the issue of poverty and from the poor themselves, running like sprinters chasing Olympic gold. No one wants to be too closely identified with the poor”.
The latest version of avoiding the poor is found in the proposed Trump-Pence-Paul Ryan-Republican health plan which converts Medicaid to block grants, meaning funding cuts, limiting federal Medicaid funds to a set amount given to the states, rather than the current federal commitment, which is more open-ended.
A 2012 study (pdf) from the Kaiser Family Foundation found that a Medicaid block-grant proposal from Speaker Paul Ryan “would lead to 14 million to 21 million Americans losing their Medicaid coverage by the 10th year, and that is on top of the 13 million who would lose Medicaid or children’s insurance program coverage under an [Affordable Care Act, or Obamacare] repeal.” A separate Center for Rural Affairs report (pdf), also from 2012, found that “changes in Medicaid are likely to have a disproportionate effect on rural areas.”
Vice-President Pence’s tenure as governor of Indiana provides more clues about where the critical safety net program is headed. When governor of Indiana, Pence implemented a policy requiring poor Medicaid recipients to make monthly payments for their insurance, or else lose benefits based on the ideology of personal responsibility. That idea could soon be going national since Trump’s nominee to run the Centers for Medicare and Medicaid Services, Seema Verma, helped Pence develop the changes to Medicaid in Indiana.
In a statement following Verma’s nomination, Physicians for a National Health Program past president Robert Zarr said Verma’s “actions in Indiana signal that she will inflict cruel and unusual punishment on America’s most vulnerable citizens.”
Trump & Pence’s Republican policy clearly exposes their colors as “reject Medicaid expansion” advocates. What kind of people are we that we elect individuals like this to take charge of our federal and state governments? Denying poor people basic mental health, medical and dental care simply because they cannot pay the premium defies logic. Does sentencing poor people to receiving little or no mental health/physical health care truly motivate them to find money that they don’t have in order to provide them with the “dignity to pay for their own health insurance”?
We must stop the war against the poor and middle class by implementing a solution standing in plain sight. It is a more efficient, affordable and humane system for universal coverage in the public interest: H.R. 676, a bill now in Congress for single-payer national health insurance, a “Medicare for All” plan based on medical need, not ability to pay. “The Expanded and Improved Medicare for All Act” (H.R. 676) would finally resolve persistent problems of Medicaid, Medicare and other failed for-profit market policies and provide health care for all citizens of the USA.
F. Douglas Stephenson, LCSW, BCD, is a retired Gainesville, Florida clinical social work
psychotherapist and Member of Physicians for a National Health Plan, PNHP.
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