The Conversation

The Medicaid bait-and-switch

The White House has, according to insider reports, pretty much given up on defending most of ObamaCare, and is planning a 2014 political strategy that will focus heavily upon its Medicaid expansion.  All the old technocratic pretensions of "reforming" health insurance and "improving" it for everybody will be cast aside, in favor of good old-fashioned Big Government welfare-state vote buying.  

Out: "If you like your plan, you can keep your plan!  The average family will see a $2400 savings!"  

In: "You can't repeal ObamaCare, because it shoved a few million more people into dependency on a welfare program, and they'll march to the polls to take revenge against anyone who threatens their benefits."

Combined with this naked dependency vote will be the usual appeals to the benevolence of the American people, who will be told to stifle their selfish complaints about their tripled premiums and canceled plans, because at least poor people are finding their way into Medicaid.  That's generally an effective strategy for selling Big Government to the dupes, who are conditioned to think that the alternative to massive, corrupt, expansionist, over-priced bureaucracy is callous anarchy.  It's either ObamaCare or dead moppets lining the streets.  Your choice, America.

But the point of the Medicaid expansion is that it's not just about getting medical care to desperately poor people any more.  One of the earliest ObamaCare "success stories" was about a law student who got past the HealthCareDotGov bug swarm and was delighted to discover he qualified for Medicaid.  A large number of people who used to have private-sector paid insurance they were happy with are going to get blown into the hellish ObamaCare exchanges... and then routed to Medicaid, which is not "insurance" but a welfare program, paid for by other people.  Dependency will be increased enormously, including the dependency of state governments on Uncle Sugar to pay 70 or 80 percent of the tab for expanded Medicaid services in perpetuity.  They'd better join Lando Calrissian in praying that Lord Vader does not alter the terms of the deal any further.

Democrats and liberal pundits are already high-fiving each other because they think the Medicaid strategy can't miss - it won't matter how badly the rest of ObamaCare crashes, because the new army of welfare dependents means the Affordable Care Act can never be repealed, and Democrats can mitigate their 2014 electoral losses by using Medicaid as a club to beat Republican critics.  Actually, I think they're underestimating the scale of ObamaCare's failure.  Liberal guilt works when everyone thinks other people will pay the freight.  They're even gullible enough to fall for the free-lunch promise of deficit spending, without realizing that every deficit dollar is just a tax increase in the larval stage.  But when they're looking at 200 percent insurance premium and deductible increases, they might not be mollified to know that their involuntary sacrifice will help make Medicaid bigger.  Especially if they do a little research to discover how Medicaid was doing before ObamaCare came along.

I think the American people will always insist on medical services for the desperately poor, and it speaks well of them.  A single, carefully means-tested program is better than an inscrutable maze of benefits, or the murky practice of "cost-shifting," in which the indigent show up at emergency rooms for "free" treatment.  (It's not much remarked-upon now, but at one point in the ObamaCare debate - during the Supreme Court hearings, if I remember correctly - we learned that the cost of cost-shifting is actually much less than widely believed, but it's still inefficient and opaque.)  It is imperative that we be completely honest with taxpayers about how much all welfare programs cost, police them aggressively for fraud, and make sure that only the truly indigent are able to sign up as beneficiaries.  Otherwise, dependency becomes a virus.


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