Medicaid: T-Bones and Cadillacs

[phantom power]

Medicare For All.

I have a neighbor, let’s call him “Fred”, who is a mid-level corporate manager who just switched back to managing part-timers on a night shift. It’s probably the worst job his (mostly unionized) company offers, and it attracts workers who aren’t that well-educated, most of whom are working poor.

Fred and I were having one of our every-so-often conversations about the world and its problems, and he was bringing up some of the problems his workers and their friends have. One of them is the loss of benefits after crossing an income threshold. If you’re one of Fred’s employees who is a high-school graduate with a couple of kids, and you’re on Medicaid, there’s a point where making a few dollars more means the loss of those programs, which is a huge hit. You’d have to make $1,000 a month more to afford private insurance, if you could get it, to replace Medicaid.

So, what tends to happen is some of these employees will reject extra hours, or they’ll have a second go-nowhere job that pays them cash under the table. Fred identifies this as a problem with “welfare”, and he’s roughly right. There are structural incentives to stay on Medicaid, because the distance from making enough money to be Medicaid-ineligible, to making enough to afford private insurance, is pretty big.

This is old ground and Fred has covered it before, but what was interesting about our conversation was that he said, out of the blue, “Maybe Obamacare will fix that”. And maybe it will–if the transition from Medicaid to premium support for a policy that has decent coverage doesn’t mean going off a $500-a-month cliff.

Fred is fairly conservative: people need to work harder, too many handouts, taxes are killing him, etc. He’s also a bit of a bigot, and a self-described asshole, but he’s not blind. He knows, from experience, what it means to be working poor. He sees the hard life and disincentives to making the jump to the middle class. He’s certainly not the poster child for empathy, since most of the pain he feels is when he has to scramble to fill a spot because an employees can’t work extra hours. But he’s not buying the welfare-mothers-in-Cadillacs fantasy about poverty that people with his political attitudes might otherwise spout. And because of that, he knows that Obamacare, if implemented correctly, will actually get people “off welfare”, meaning into the middle class.

If, instead of a trip to the salad bar at Applebees, David Brooks worked on a loading dock at 3 AM in the middle of the winter, let’s say for a week, he might have a bit of the insight that Fred has, even though Fred has never read Hayek or Burke, or attended the Aspen Institute.

http://www.balloon-juice.com/2013/04/02/t-bones-and-cadillacs/

[hedgehog]

1. My 60 year old BIL who works a physical job is ready to retire -

but he can't afford private insurance this year. Maybe next year when the health care exchanges kick in...