Medicaid. It is the United States Federal
Government program to aid states in providing health care to the poor and
impoverished who otherwise could not receive proper
medical care. In 1995 the federal
government spent a total of $77.4 Billion on Medicaid. This is up almost 300 percent from $20.1
Billion in 1984, only 10 years earlier.
In the same 10 years state spending on Medicaid rose over 250 percent
from $16.5 Billion to $58.2 Billion.
Under the current Medicaid programs, Medicaid spending will increase at
an annual rate of 10 percent, to an estimated $262 Billion by the year 2002.
Medicaid spending has grown much faster than
the general rate of inflation. For the
Federal Government, Medicaid expenditures have grown from only 1 percent of the
national budget in 1970 to over 6 percent in 1995, while state expenditures
went from 8.1 percent to 13.5 percent in the same time span. This increase can be attributed to multiple
factors. First, through a series of
mandates, the Federal Government has expanded the eligibility for Medicaid,
requiring states to serve more people.
They also increased the standards required of nursing homes. This led to higher nursing home costs which
were passed directly back to the Medicaid program. The current average cost to care for a
patient in a nursing home is nine times greater than that of a single dependent
child. The price of medical care, in
general, has drastically increased.
Expensive new technology and procedures are a large part of this
increase. The need for these costly new
technologies is not expected to decrease, the cost will just be passed on to
the public through higher prices and higher Medicaid spending. And finally, an estimated 10 percent of
Medicaid payments is wasted on fraud.
This is mostly fraud by health care providers, with a minuscule amount
from patients with forged documents.
From 1985 to 1993 Medicaid enrollment has gone
up 53 percent. In the early 1970's,
Medicaid recipients were at 8 percent.
Today more than 13 percent of the U.S. is receiving Medicaid's
assistance. If there was no Medicaid,
current cuts in employer sponsored medical coverage would have increased the
uninsured population from 41 million today to an estimated 50 million people.
The politicians are finding themselves in a
complete catch-22. If they try to cut
Medicaid spending, they fear they will appear cruel and insensitive to the poor
and disadvantaged voters, and also voters who sympathize with their
plight. But if they don't try to cut
spending, they will be criticized for not trying to cure our current budget
deficit. But while our elected officials
sit on the fence, trying not to offend anyone, they alienate everyone by not
acting while this Leviathan digs us deeper and deeper into debt.
In his Justice as Entitlement theory, Robert
Nozick describes his view of social justice.
He states that aside from nontransferable natural rights like life,
liberty and happiness, justice is to do with holdings, and that government is
to have as small a part in the lives of its citizens as possible. This is his idea of the Minimal State.
Justice as Entitlement, as he puts it, has
three major parts. First is how people
acquire their holdings, Justice in Acquisition.
This states that if a person acquires their holdings by their own labor,
without violating the rights of others, then this holding is just. It is each persons responsibility to work to
support themselves and their families.
Next is the idea behind transacting business, or Justice in
Transfer. This principal states that if
a person gives something of their own free will, then this holding is also
just. These are the only fair, reasonable,
just ways for a person to acquire anything.
Any other way, and the holding will be considered unfair. Finally, there needs to be a way to correct
unjust holdings. If a person can provide
proof that their holdings have been taken unjustly, then the holding is unjust
and reconciliation can be made. However
these must be specific claims with specific proof of specific actions.
Next, the Minimal State is Nozick's idea of
what a government should, and should not, be.
He states that government has the obligation to protect its citizens
from theft, force, fraud, and also to enforce contracts. He states that any more extensive a
government will violate its citizens natural rights. He also says that a government must not
prohibit activities of its citizens for their own good or protection, and it
cannot force any citizen to aid another
citizen against their own will.
With these two major principals we can
determine, basically, what his views on the current plans for welfare
reform. With the Minimal State
principal, we can clearly see that in Nozick's view, the state has clearly
overstepped its bounds. It is forcing
U.S. citizens to pay taxes that will directly be spent on medical care for
impoverished citizens. Many are paying
against their will. Some citizens think
that the health care of these people should care for themselves or be cared for
by their families. which leads to his
Justice as Entitlement principal. These
needy people are receiving money, or holdings, from the state. They did not work for this, it was a transfer
from the taxpayers of this country.
Since many feel that this is not their responsibility, it is against
their will that this money is spent on caring for financially challenged
individuals and families. I believe that
Robert Nozick would consider the entire Welfare system to be unjust.
The American philosopher John Rawls, however,
has a far different idea of social justice.
In his theory of Justice as Fairness, Rawls states, like Robert Nozick,
that every person has inherent rights to basic liberties. These include life, freedom, happiness, all
nontransferable, and the one transferable liberty, the right to hold
property. But from there, their views
differ.
One of the main points in the Justice as
Fairness theory, is the Principal of Difference. Rawls states that all positions within a
society should be open to all. Everyone
should have an equal chance of getting to any position within reason. He also states that wealth should be
distributed to everyone based on their contributions. The owner who puts up capital for the
business, the manager who has the knowledge to make the product, and the
laborer who puts in the hard work and effort are all entitled to their own
portion of the wealth that has been created through their concerted
efforts. He also states in this
principal that disadvantaged people should be given compensation if their needs
require it. Many people work hard and
still can't make ends meet.
In the U.S., the poor are disadvantaged in more
than one way. The higher education
required by many professions are beyond the means of most. Not only can they not get the education to be
competitive for jobs, they are exploited by the employers who may not be
compensating their hard efforts fairly.
These problems should be dealt with by the government. They should provide for the needs that the
disadvantaged incur that they can not take care of for themselves, especially
something as basic as decent health care.
The current programs are not enough, there are many people going untreated,
and now they want to cut funding, this will prove fatal for some people.
In these tough economic times, times of
downsizing, layoffs, and cutbacks, the people who continue to be hurt most are
the poor. With funding for education
being cut, they have less of a chance of being competitive in the current job
market. They are unqualified for the
higher paying jobs that haven't lost medical benefits. Nor can they afford personal health insurance
with the meager wages they earn.
These hard working men and women, their
dependent children, and their convalescent parents also need medical
coverage. They need x-rays,
chemotherapy, to have babies, tonsillectomies,
infant immunization, and nursing home care. If current plans for Medicaid reform are
enacted, many will loose even this last chance to receive decent medical
care.
John Stuart Mill's theory of Utility states
that an action is good if it produces the greatest amount of happiness for the greatest number of
people. While all U.S. taxpayers would
like to close the budget deficit within the next six years, most would not want
to see the elderly, expectant mothers, and especially children, without
acceptable medical care. Under this
philosophy, reform would be preferred, and greatly appreciated, but not at the
cost of these innocent peoples health and lives.
Using Immanual Kant's theory of the Categorical
Imperative, one can get another view of whether we are doing the right
thing. The categorical imperative states
that if you take any action and universalize it, make it applicable to any
person in the same situation, and it
remains acceptable, then this action is good.
If someone had the means and was given the chance to aid another person
who desperately needed it, would there be any circumstances in which it would
be good not to offer your assistance. No
rational human could refuse such an act (if they were using the categorical
imperative to judge by). Medicaid is
just a centralized system of doing just that.
Even though it's not working to its best possible effect, could anyone
refuse to take part?
People, in this country, need to overlook their
own greed. If they see that the money
they work hard for is going towards bettering human life, even just one, I
believe that should be reward enough. I
don't believe that my money is being used to its best extent in respect to
Medicaid. There needs to be major
reforms in the way money is apportioned and used. There also needs to be a decrease in the need
for Medical. Through incentives to businesses for
providing health coverage to applicable employees, i think that this is an
attainable goal. The current state of
the Medicaid program is grim, but what would be the state of our nation without
it.
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