Weekly Briefing

The right's radical health care plan for people in need

It's right-wing myth-buster time. Here's one with which we're all familiar:

"We've got to get a handle on these entitlements. Too many North Carolinians are entitled to too many free, Cadillac-quality public services - particularly in the realm of health care. Now is the time to stop these giveaways to the poor so that they'll have an incentive to get out there and pull themselves up by their own bootstraps."

You don't have to look far to see how this type of thinking has infiltrated and clouded our collective vision. Heck, just a couple of years ago, the supposedly "liberal" North Carolina Senate took such a position in its budget negotiations with the House as it proposed cutting 65,000 aged, blind and disabled people from the state Medicaid rolls.

Like a lot of myths, it's hard to pinpoint exactly where and when this one got its start. Many of us remember Ronald Reagan's rants about "welfare queens" who supposedly lived like royalty on the public dole. Here in North Carolina, successful conservative politicians like Jesse Helms helped propagate this myth and former Senator Lauch Faircloth made it a centerpiece of his successful campaign against Terry Sanford in 1992.

Today, the chief proponents of the myth are the denizens of the state's market fundamentalist think tanks. These groups make it a regular practice to release mock state budgets and policy wish lists that magically uncover billions in potential "savings" by casually lopping off tens of thousands of people and/or dozens of core public services as "non-essential." What these proposals almost never include, however, is a careful, real world examination of the services in question or the people that would be affected. Like myth-makers that came before them, these groups seize upon (or even manufacture) incidents and anecdotes of abuse or bureaucratic foul ups to justify the wholesale elimination of entire categories of core services.

Medicaid myths

A regular case in point can be found in the annual proposals of the Raleigh-based John Locke Foundation. For many years, the Locke people have offered up a series of policy prescriptions to state lawmakers and candidates for office. The latest of these, Agenda 2008: A Candidate's Guide to Key Issues in North Carolina Public Policy, trots out many of the group's tired old "solutions" to the challenges that confront our state. Most involve underfunding or defunding various public initiatives or doing away with some form of consumer protection regulation.

One of the most significant, but poorly explained regular features of these "guides" is the claim that North Carolina can reduce spending on Medicaid (the public health insurance system for people of low income) by simply doing away with so-called "optional services." This year's "Agenda" makes the assertion in a half-sentence buried deep in the document.

"State policymakers should significantly restructure Medicaid. The benefits package should more closely resemble private plans and be limited to services mandated by Washington." (Emphasis supplied.)  

Hmmm. Sounds reasonable at first blush. Why should North Carolina be providing Medicaid services that are more generous than those required by the federal government anyway?

Well, here's why. The floor established by the feds is truly only that - a "floor" - a baseline level of services that is designed not as a complete package, but as a rudimentary framework upon which states can build their own systems.

It's kind of like buying a primitive new car in which things like wheels and heat and windshield wipers are "options." It's theoretically possible to imagine a scenario in which one might opt for the baseline model and then cobble something else together by scavenging junkyards, but completely impractical.

And so it is with the Locke Foundation agenda. Instead of providing the poor with something akin to a reasonably complete package of benefits, the group urges that the poor be provided with tax credits and/or vouchers that they would use to buy private insurance or deposit in "health savings accounts."

What the "Agenda" fails to tell the reader is that limiting Medicaid to "services mandated by Washington" would deprive hundreds of thousands of poor North Carolinians - young, old and disabled - of numerous and undeniably essential health care services like prescription drugs, dentures, prosthetics, eye care and eye glasses, hospice care and two dozen other "extravagances" (more on these below) of the same general character.

Got that? The "Agenda" reaps millions in illusory potential savings by recommending, in effect, that North Carolina's poor be required to scavenge the junkyards of society to get their basic healthcare.

A poisonous message

In other words, the proposal is an absurd fraud - an impractical, radical, and politically implausible set of suggestions that has no chance in the real world of winning approval from the North Carolina General Assembly (or any other state legislature). Unfortunately, because it is presented in such a self-assured and almost offhanded way, most readers (journalists? candidates?) speed right past it and buy at least partially into the underlying idea - that North Carolina's Medicaid program is some kind of champagne and caviar system that bestows all sorts of luxurious goodies on its beneficiaries.

As noted, this is a familiar practice with the anti-government right that's not confined to health care policy: Make broad generalizations about supposedly extravagant spending in public programs and then advance half-baked "solutions" that would slash spending across-the-board while failing to account for the real world impact of the proposed cuts.

In the past, for example, the Locke Foundation has launched many such broadsides against public education in which it has attacked well-paid teachers, decent space for arts and athletics, and well-lit, public gathering places. It then attempted to portray such items as gold-plated excesses that justify across-the-board spending cuts and privatization initiatives - never acknowledging, of course, that, for all its imperfections, the overwhelming majority of spending on public education goes to core functions like classroom instruction, buildings and books.  

And so it is with most public programs. The right seizes upon some vulnerable item (even if it's only vulnerable in their cramped and twisted view of government) and then, rather than merely playing the role of watchdog, it extrapolates to some grandiose conclusion about government in general and the need for huge spending cuts.

Make these claims enough and mix in a measure of the real waste and malfeasance that are unavoidable in any large human institution (public or private) and the next thing you know you've helped breed and promote the kind of cynicism about government that afflicts so many Americans today.  

Going forward

The only answer to these kinds of cynical manipulations, of course, is to speak the truth. Thinking people must answer the right's attacks and demonstrate wherever possible the real and practical implications of the kinds of radical policy prescriptions that the market fundamentalists promote.

When it comes to North Carolina's Medicaid program, this means identifying the specific kinds of services that the right thinks ought to be discontinued and reminding people of just how important they are (and where most of the money really goes).

Over the next few weeks, NC Policy Watch will be doing just that by highlighting several of the "optional" (and according to the Locke foundation, expendable) services that North Carolina's Medicaid program provides on The Progressive Pulse blog. We hope you'll check the website periodically to be reminded what some core government services are really about and of the importance in using caution in reviewing the policy assumptions of the market fundamentalist right. See you on the blog.

 Email This Post  Print This Post

This entry was posted on Tuesday, September 2nd, 2008 at 11:28 am and is filed under Weekly Briefing. You can follow any responses to this entry through the RSS 2.0 feed.