At the time Medicaid was proposed, it was supposed to cover “the poor.” Medicare was supposed to cover those who reached retirement age and also those who lost their breadwinner due to death or disability. Combine these two programs with a large and growing number of breadwinners gaining hospitalization or more comprehensive plans, and we would have something approximating universal coverage.
This was how it was supposed to work.
It didn’t.
Why?
Reason #1 (and this is only reason I will develop in this comment) is because there is no magic line between the poor and those who can afford private health insurance.
As a result of the liberalization of AFDC (welfare) and Medicaid, birth-rates among never married black females sky-rocketed and birth-rate among never-married white females followed. With a child in tow, the female and her children qualified for an apartment, welfare cash, food stamps and a comprehensive package of health care to include dental and vision. Also, Pell Grants when they came along.
What low-wage male could provide that package of benefits to his family.
The men would simply cohabitate with the mothers of their children. Well, until marriage broke down entirely and the village completely replaced men as breadwinners, fathers of children and husbands of wives.
At the other end of the life cycle, people with few if any assets learned to become qualified for Medicaid nursing homes. Who, among even the middle-class could afford a private nursing home, no less those among the working class.
So, Medicaid grew by leaps and bounds. Much faster than the general population and the cost of living combined.
In theory, Obamacare was to fix the biggest single problem of Medicaid by offering sliding scale subsidies. This way, a person doesn’t go from 100 percent subsidy to zero subsidy upon crossing whatever is the threshold (perhaps 125 percent of the poverty line or 150 percent). This way, there would be a positive incentive all up and down the income distribution to work more hours, whether this meant increasing work from zero to part-time, or from part-time to full-tim.
But, the reality is this has not worked out.
Not at all.
Obamacare has blown up.
So, the working class of the country are caught in an untenable situation. Even with the subsidies, they cannot afford to work full-time. For many, they have to work part-time and learn to make do with food stamps, Medicaid, the earned income tax credit, and who know what other subsidy programs, along with what cash earnings they can earn without losing cutting off their benefits.
Unfortunately, the majority of the Republicans in the Senate don’t have an f’n idea of what’s going on. They were born into families of privilege. They do know the people who are being screwed by the system, and they don’t want to know them either.
And they hate Donald Trump in large part BECAUSE he is in touch with the working class of the country.
Excellent post.