Medicaid Expansion and Other Things

 

First, I’m grateful to be online again after Friday’s storm knocked out our power.  There are many people in my area, near Washington DC, who will not get power back for days.  So I’ll take this opportunity to thank the people out there cutting up trees that have fallen, repairing lines, and helping in general to recover and restore things, all out in record heat…and when I say record, I mean record.  Friday was the hottest June day in the DC area in 142 years of record keeping, breaking last year’s record by 2 degrees.  It was 109 degrees F in Nashville; the heat definitely contributed to the severity of the storm, which was also one of the worst non-hurricane wind events on record in this area, and all along its path.  Winds gusted to 79 MPH in Reston Virginia, 77 in Swan Point MD, 71 at Dulles airport.  I’d make some snarky comment about the global warming deniers, but what’s the point?  This won’t convince them either.

There are several things to comment about, but let’s look at one part of Sarah Kliff’s Wonkblog story in the Washington Post about the Supreme Court’s decision about the Medicaid expansion section of the PPACA (“Obamacare”, or sometimes “ObamaRomneyCare”).  The Court said that the Federal Government can’t penalize states for not participating in the extension of Medicaid in the new law by reducing funds they would get under ordinary Medicare provisions; they, the states, won’t get the additional funding for the new provisions if they don’t participate, but the Feds can’t penalize them any further than that. 

And actually, I don’t want to comment on that decision, or intervene in any individual state’s decision about whether to participate in the new Medicaid extension or not. That’s up to them.  But I do want to comment on one line, because it relates to something that I’ve said here before.  Here’s the main quote:

“There’s one really big incentive to expand Medicaid: a huge sum of federal money.”

Unfortunately this may be the incentive that many state governments recognize.  I say unfortunately because money should not be a prime motivator for government.  For a government money is a tool, not a goal. Governments, again, are not households, and they are not businesses.  Their motivation is not household vacations or transportation to work or saving for retirement, or finding love or shelter for themselves.  Their motivation is not making a profit, creating new products or trimming the workforce.  They are there not to compete with private business or to displace the responsibilities of families, but to provide an environment in which businesses and families can thrive, in which there is fair opportunity for everyone.   Governments do that by providing defense, justice, infrastructure, education, and yes, the wide availability of clean air and water, food, shelter, health care and other basic needs.   Governments use money to do these things, but money is not the purpose of government’s existence or the measure of its success, and it should not be a major motivator for its decisions.

A bit later in the story she comes closer:

“…the Medicaid expansion sounds like a real win: … It would be a big help to local hospitals and doctors, who often get stuck with uninsured patients’ bills. And it is likely to drive down the cost of health care for everyone; studies have found higher rates of uninsurance to be associated with higher costs for everyone else.”

THAT describes something that should motivate government: the general welfare of the citizens it represents.