Avik Roy responds to my last post. I appreciate that he took the time to do so. There needs to be more talk across the ideological divide.
Still, I stand by what I said. In my further response to him, I’m also unimpressed by Roy’s bromides regarding Medicaid’s furtherance of “welfare dependency, that leads to family breakdown and social disrepair.”
Author: Harold Pollack
Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.
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5 thoughts on “Roy vs. Pollack on health outcomes, Medicaid, and welfare dependency”
(Harold): “Iâ€™m also unimpressed by Royâ€™s bromides regarding Medicaidâ€™s furtherance of ‘welfare dependency, that leads to family breakdown and social disrepair’.”
Do you assert that this does not happen?
I think this is one of those things about welfare in general that is difficult to prove either way. What we do know, is that people who need medical treatment are getting it. Personally, the idea that the prospect of some meager government assistance disincentivizes people to be more successful than they otherwise are doesn’t make much sense. Anyone satisfied with living in poverty already likely has some pretty big issues, enough that government assistance would present a small portion of the total disincentive structure. Certainly the degree to which this effect is occurring, it is outweighed by the moral and civic good of helping the majority of recipients through hard times.
“Welfare dependency?” Are we kidding? And all Avik Roy could cite was Charles Murray’s flawed analysis in “Losing Ground?” Christopher Jencks and other reviewers with knowledge of the subject destroyed that book when it released. One didn’t even have to consult the more radical sociologist, William Ryan, whose “Blaming the Victim” was still a powerfully reasoned and empirically supported book.
Jencks and others such as William Julius Wilson, who studied America’s then welfare system, and analyzed welfare rolls over decades, showed that most who were welfare were women and children. Most of the men on welfare tended to be employed throughout much of each year. The women who were on welfare had slightly more children than non-welfare mothers, particularly less than one extra child per capita. In the 1970s, over 70% of the welfare mothers had 2 or less children. Welfare mothers went on and off welfare. Many worked, but lost their menial jobs when children became ill and they missed three or more days in a week–and were fired from their jobs. In the 1990s, Robert Reich proved that there was more corporate welfare costs to the federal government than the cost of the AFDC, but still “welfare deform” passed anyway, and corporate welfare remained.
I know trust fund children who have grown up to be irresponsible adults. But I know many more who grow up just fine. I have seen people on welfare who can’t shake poverty. But I am aware of many more who had welfare from the 1930s through the 1980s who grew up to become responsible reasonably economically successful adults, or women who said “Thank God I had that safety net when I needed it after my divorce.” In the 1960s, I personally saw people receive welfare checks with tears of gratitude in their eyes, standing with their small families thanking providence for a small sum of money that would keep them fed and housed for a few more weeks–and that was when as a child I went with my father, a local appointed political official, who made a few personal deliveries of welfare checks to people who would not open mail from the government, assuming it was a bill they could not pay, or had just moved.
Avik Roy was insulted that Harold called him insensitive. Harold was too kind. Roy is a putz. He does not know the sociological literature, and I daresay he speaks in that technocratic lingo that tells me he’s never met a person who was on welfare. Ignorance is not bliss in this instance. Ignorance on his part is what Michael Harrington called an “indifferent cruelty.”
As for anyone else, it is disgusting to even use the phrase “welfare dependency” at a time when we hardly have an inheritance tax, income taxes remain low for the global elite who live in the US, we can’t even enact decent job creation programs during the worst recession since the Great Depression, and when we are witnessing a civil war within the working and middle classes where put upon private sector workers are told by corporate media to hate their public employee co-workers.
There is a huge gulf between welfare meaning “income support,” and Medicaid. I know many, many people who work full time but qualify for Medicaid for themselves and their children. If their employers even offer health insurance, the premiums are higher than their rent. Actually, raising the income limits for Medicaid eligibility is an incentive to work. Mr. Roy needs to look beyond his charts and graphs.
The whole “they go to different hospitals” line of reasoning and the conclusions drawn from it seem disingenuous to me at best. Of course people living in poor areas and sporting lower reimbursement rates go to different hospitals than the better-off. But how would that change if they were uninsured, or privately insured with the kind of policy Medicaid money could cover? (Perhaps a few of them would end up at the front door of a better hospital too sick to be transferred, but I find it hard to believe that would make a substantial change in outcomes.)
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