This morning, the Trump administration announced that states that wish to impose work requirements for Medicaid recipients may do so. This is not at all surprising, but it is disturbing.
Now I’m not interested in the actual motivations of the people running the show, given that they are A) morally hopeless, and B) so deeply loathsome that one cannot even use garden-variety insults to describe them without feeling sorry for the object or body part being compared to them (I mean, really, what did an anus ever do that was so horrible?). However, the argument they offered for it is pretty interesting, so let’s talk about that.
You might think it would’ve been all about how they were concerned with reducing the deficit (you know, that thing they just increased last month with their giant tax cut for rich people). Actually, their motivation, according to them, is purely charitable: they are going to increase the mental well-being of poor people by making their health care benefits dependent on their employment status. Yes, really. Somebody said that with a straight face in front of reporters.
‘”Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries [by making it harder for them to get health care], and today’s announcement is a step in that direction,” said Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services.’
‘”Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said.’
‘”This is not, as some would have you believe, a punitive action aimed at recipients,” said [Republican Governor Phil Bryant]. “It will actually help this population reap the rewards of a good job [or of a really crappy one that pays poverty wages and treats them like toilet paper, since that’s probably the only kind of job they’ll be able to get].”‘
(bold portions are mine)
While there will be exemptions for children, elderly people, and people who are considered legally disabled, this requirement (in states that choose to implement it) will add an additional bureaucratic hurdle and make health care inaccessible for people who are not “legally disabled” but are nevertheless unable to work at the jobs actually available to them. In many cases, these will be people with mental conditions and/or health problems that are disabling but don’t meet the official criteria for disability. Withholding health care from these people is both immoral and counterproductive.
But oh! The administration is allowing for volunteer work and other forms of “community engagement” to fulfill the work requirement. So what’s bad about that? What’s bad about getting people engaged in their communities?
Well, nothing … I mean, community engagement is good. Work is also good. Not looking at the systemic obstacles to engaging in work and one’s communities, while simultaneously threatening people with poor health and maybe death if they don’t engage in those things, is not good.
What’s really toxic about this whole thing is its view of the person.
First, although Verma refers to “the soft bigotry of low expectations” of those who oppose who work requirements for Medicaid, it is those who support them who really have low expectations. They expect that people do not want to be active in their communities; that people do not want to work; that people do not want to be meaningfully occupied. I strongly suspect that most people actually do want these things, and that in most cases of unemployment and disengagement it is not a lack of desire that interferes or even necessarily a lack of ability, but a lack of opportunity.
Thus, Republicans are ostensibly trying to address a problem that doesn’t exist (lack of motivation) while ignoring the actual problem (lack of opportunity), which is largely a product of their own economic policies.
Furthermore, the belief that community engagement can somehow be measured by the government (this by people who claim to believe in less government), that one’s contributions to society can be quantified and deemed worthy or not worthy of medical care, is so toxic I am coughing on the fumes right now.
I believe that everybody should be housed, fed, clothed, and provided medical care, to the extent possible in a given society, because they are people living in that society. And then – THEN they can give back. Not the other way around. Take care of people’s basic needs, and they will seek out mental and spiritual fulfillment in the form of work and caregiving and volunteering and art and science and dialogue and meditation, and in so doing they will enrich their communities. It’s Maslow’s hierarchy of needs, people! The foundation is those basic, physical needs on which life depends. Family, self-esteem, creativity, risk-taking, all builds on that foundation. You can’t turn the pyramid upside down and expect it to balance.