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Friday, March 26, 2010

Let S/he Who Has Not Sinned Decide who are the Deserving Poor

I recently read a blog post from one of the few libertarian bloggers, Milena, that doesn't cause me to sputter like Daffy Duck at my computer screen. It was about one of this country's favorite topics which is, who are the deserving poor and who are the undeserving poor? Whenever there is talk of expanding a safety net benefit like unemployment insurance, food stamps, or something really crazy like health insurance expansion, the following proclamations are issued:
  • These people live a lifestyle of luxury on $400/month! When you give people just enough money to not starve or be homeless, they have no incentive to ever get a job!
  • I know an obese person on food stamps who eats junk food all day! They should only let people on food stamps eat vegetables and drink skim milk!
  • I have a job with health insurance! Why should people without jobs have health insurance! They clearly must f#cked something up if they don't have a job with health insurance!
Milena's blog post connects the food stamp program with artists and uses that angle to examine the government support/subsidization of art. The idea of using safety net programs for a specific field is an interesting concept. However, the idea of asking who deserves access to these programs is not as interesting.

One of the few things that I learned in social work school is that the country's safety net programs were set up very differently if the recipients were thought to be deserving poor compared to undeserving poor. Medicare and Social Security were for the deserving poor, or elderly who had spent their lives contributing to society and needed a retirement program that didn't involve being broke and slowly dying in a hospital. The enrollment process is very easy. Turn 65 or 62 and the government signs you up automatically.

Thanks to the National Kidney Lobby, if you have End Stage Renal Disease, you are also deserving poor. You automatically get signed up for Medicare health insurance if are diagnosed with the disease no matter how old you are. However, if you have tuberculosis and can't work, it's too bad so sad.

If you need cash assistance from the state or want to qualify for Medicaid health insurance, the enrollment process alone makes it very clear that these are for the undeserving poor. It requires extensive documentation to overcome the assumption that you are not spending extensive amounts of time and effort to cheat the government out of approximately $400-$600/month. If someone was skillful enough to defraud a government assistance program, they would use those talents on a much higher scale and defraud the private sector of millions.

What about Ronald Regan's welfare queen who had "eighty names and 12 social security cards" to defraud safety net and government assistance programs of $150,000/year? She was never proven to exist. There was a story about a woman who managed to defraud welfare programs for $8,000 with 4 aliases before being arrested. As I had said before, it's really hard to defraud government assistance programs for a large amount of money without getting caught. If Regan's welfare queen was as good as he claimed, she would find more lucrative opportunities.

As a result of dividing the poor into deserving or undeserving, we create extremely inefficient safety net programs. Programs spend money on more administrative aspects, create additional bureaucracy, probably deny assistance to beneficiaries who should receive it, and operate a program based on the exception rather than the norm.

If I were president and could force Congress- no, that's not realistic. The president can't even force Congress to be polite during his speeches. If I had enough weapons and bombs and barricaded Congress in a building, here are the 2 choices that I would give them to reform our safety net and assistance programs:

1. Create a program that follows 90% of behavior and assume that all poor are deserving: If someone's income or disease state prevents them from supporting themselves, simply allow access to entitlement programs. Being on these programs is not a life of luxury so 90% of all applicants are not trying to defraud the system but simply need help. There will probably be enough savings from removing the extensive application and review process to expand programs somewhat.

2. Assume all poor are not deserving and end the programs: Let the exceptions rule and just end assistance programs that are a charade or promise of assistance. For those who don't want to subsidize health insurance, then let's end the Emergency Medical Treatment and Active Labor Act (EMTALA), also known as not letting hospital emergency rooms deny treatment based on ability to pay. Why start paying for services when someone collapses on an emergency room floor from a very treatable chronic disease but refuse to pay for the doctor office visit to prevent it? That is completely economically inefficient and still fairly heartless. For the libertarians, let's just be heartless but at least be fiscally consistent.

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