A while ago, when Republican Rep. Paul Ryan was embracing his Inner Compassionate Conservative by releasing his anti-poverty program, which included a “customized life plan” with a personalized contract with benchmarks and timelines, I noted that his idea was liberalism as designed by fucking morons:
…what Paul Ryan wants to do is create a government bureaucracy to monitor these ‘contracts’ (or, maybe monitor the Social Contract?). Conservatives have spent the last forty years railing against this very thing. Of course, people will disagree about whether they hit these ‘benchmarks’, so we’ll need to hire people to adjudicate that process. More ‘big government.’ It also opens people up to the predations and whims of ‘petty government bureaucrats.’ Maybe some will be lenient and kind, others might not. Seems like there are plenty of opportunities for abusing and preying on the needy–which already happens.
When you look at the two of the most successful anti-poverty programs, Social Security and SNAP, they don’t involve a lot of monitoring (SNAP does have some limits on what can be bought). They just disburse money to those who need it. Ryan’s plan isn’t liberalism, it’s liberalism as designed by a fucking moron who hasn’t been paying attention for the last three decades.
Well, it appears Republican governors are adopting Ryan’s approach and applying it to healthcare (boldface mine):
In practice, however, crafting plans that are ostensibly more conservative has tended to add layers of bureaucracy and administrative complexity. The Republicanized versions of Medicaid thus far have ended up more complicated, confusing, and possibly costlier than the program Republicans refused to expand in the first place.
Take, for example, Arkansas, the state that got the ball rolling for red states seeking GOP twists on Medicaid expansion with its privatized version known as the “private option.” Last month the state got approval for a byzantine new program, called Health Independence Accounts, that imposes co-pays on some beneficiaries unless they pay a small monthly fee. Those who have paid their fees are eligible, under certain conditions, for up to $200 to pay for the costs of private health insurance if their income goes up and they transition off of Medicaid. To run the program, the state will pay a third-party administrator about $15 million annually (covered by the feds as part of the cost of expansion).
Meanwhile, Iowa is now imposing low premiums, tied to a wellness program, on some beneficiaries. “The administrative complexity of the system the state is contemplating is somewhat mind-boggling,” Joan Alker of the Georgetown University Health Policy Institute commented when Iowa’s waiver was approved, adding that “[t]he wellness program is of questionable policy value.” Indiana’s proposal includes small premiums and savings accounts tied to different benefits packages, leaving advocates for beneficiaries worried that low-income adults “face categorization into a bewildering array of benefit plans and options.”
These schemes will put additional bureaucratic pressure on state agencies to implement (or outsource) them. “What we’re talking about does add a layer of complexity to an already complex program,” Matt Salo, executive director of the National Association of Medicaid Directors, told me. However, he added, the additional administrative burdens were the only way to gain coverage for hundreds of thousands of people. “It’s all part of the quid pro quo,” he said. “In Arkansas, in Iowa, in Michigan, would the expansion have happened at all if not for these types of things? I think the answer is pretty clearly no.”
….“All of those ideas, leaving aside their policy merits, they all presuppose a pretty intensive level of government involvement in people’s lives,” Alker, an expert on Medicaid waivers, told me by phone. Alker points out that the original proposal by Pennsylvania suggested that the state would eventually be tracking everything from cholesterol level to work history to legal record. (In the end, the feds accepted just four of Pennsylvania’s initial 24 waiver requests.) The implicit bargain has been to offer a social safety net for the poor, but only via an intrusive nanny state.
Leaving ideology and philosophy of governing aside, these are stupid, cumbersome, and expensive add-ons. The confusion and delays these add-ons cause won’t help the delivery of services. If the primary goal were truly to help people, no one in his right would build programs like this. On the other hand, if one were trying to limit access by undesirables to these programs without explicitly doing so, this is exactly how one would design such a system.
These monitoring systems also offer opportunities for privatization contracts.
Never mind. Mission accomplished.