How I Came to Support Public Health Care Programs, Yet Despise Medicare, Medicaid, and Obamacare

A few weeks ago, SJS contributor Justin Nutt, MSW, etc. wrote an article on how he serves as a social worker while holding some decidedly conservative views.  The article set off a firestorm of comments between those social workers who identify as liberals and the many social workers who finally saw an opportunity to come out of their “conservative closet.”  Essentially, the comments came down to a discussion (if that’s the word) about the political ideology a person needs in order to become a social worker.

Justin’s article made me think about why I do the work I do as a health policy analyst, and why my views on health care are what they are.   For example, if anybody’s bothered reading my articles on Obamacare, it won’t surprise you if I said that I am an opponent of the law who believes 80% of it needs to be repealed and flushed through the septic tank of history.  Add this to that my ardent criticisms of Medicare and Medicaid.  Yet, I am just as passionately a supporter of public health care programs.  This might be seen as a contradiction, so I suppose this is my own story about how I came to be like this.

My most powerful memories, the ones that go through my mind every waking hour of every day, are of my days in the Johns Hopkins Children’s Center as a teenager and young adult.  In the late ‘80s I was diagnosed with fulminant ulcerative colitis, the genetic sister to Crohn’s disease.  To make it short, I spent the ten years between ages 15 and 25 dealing with life threatening illnesses.  I had to get an ostomy bag at 18, but was still so sick that I developed two other diseases as complications.  One was an infection that’s usually only found in dead bodies and AIDS patients.  When I was 20 I weighed almost 90 pounds less than I do now and was so incontinent that I was covered in my own feces for four months.  (It’s tough to get dried feces out of body hair.  You have to wait for the hair to fall out.)  I don’t know how many times I would have died had I not had competent medical care available.  I lost count at 23 times, but since I still have occasional problems it’s probably closer to 40 by now.  At Hopkins, those of us with autoimmune diseases were grouped together in the same ward, so I spent a lot of time with the kids who had cystic fibrosis.  I guess they’ve been dead almost 20 years by now.

With that experience under my belt, I never could have been a doctor or nurse.  I can’t stand thinking about disease anymore and I can’t be in Hopkins for more than two hours before I start suffering from flashbacks.  Instead, I gravitated towards health care public policy, which was safer for my psyche yet still afforded me the opportunity to work against the forces of illness.  My opinions on health care were formed through many hundreds of hours of having to sit through legislative health care hearings and briefings.  During all those hearings I came to the understanding that our country’s public health insurance programs are not about treating the sick.  They’re about getting votes.

Think about it: What qualifies a person for these public programs?  Medicaid is based on income.  Medicare is based on age, although there is a carve out for those with disabilities.  But surely, we’ve thought about the children, right?  Nope.  Family income is what qualifies a child for the State Children’s Health Insurance Program.  With the exception of that Medicare caveat, none of these programs consider how sick people are before they start doling out the money.  Instead of focusing the money on those who need it, they spread a little money around to as many people of voting age as they can.  The result is public insurance programs that reimburse so little that the truly sick can barely get treated because physicians can’t afford to take very many Medicaid or Medicare patients.  It’s a huge waste of money.

And believe me, there’s a lot of money being wasted.  In 2012, the Kaiser Foundation reported that Medicare accounted for 16% of the federal government’s $3.5 trillion budget.  Medicaid accounted for 7% of it.  Now consider that the Medicaid budget is matched by the states, do some math, and roughly how much does America dump into its public health care programs?  Do yourself a favor and sit down before you open your calculator app.

It’s about $1 trillion annually.  One trillion dollars each and every year.  A million dollars a million times over every year, and (as I found out during my master’s practicum) people with mental retardation are knocking their rotten teeth out with pliers because they can’t afford to see a dentist.  Ditto for the impoverished 12-year old boy who died of a toothache a few years ago in my hometown of Baltimore.

You tell me if America doesn’t have a problem here.  And as I’ve explained in a half-dozen SJS articles, Obamacare doesn’t do anything to fix this, but it does a lot of things to make it worse.

So what would I do to fix things?  If I were King of America, I would get rid of every public health insurance program in the country.  Then I would decree a new system in place.  All children from birth to 22 would have their health care paid for by the government.  Those adults with permanent and catastrophic conditions and those from age 70 to death would have theirs subsidized based on a sliding scale that considers their need, income, and health behavior history.  (Don’t ask me to elaborate, I’m just imagining things here.)  Just the focus on prevention alone from treating children, and the truly needy first, would guarantee that my “Matt is King of America Health Plan” would save far more money and be way more effective than Obamacare could ever hope to.

And that, ladies and gentlemen, is how I came to support public health insurance programs while despising the political monstrosities that are Medicare, Medicaid, and Obamacare.   Maybe you, too, would hold a similar view if you were a senior health care policy analyst who has had to experience seeing the looks on your parents’ faces as you lay screaming on a gurney in an emergency department, or if you’ve ever had friends who died from the autoimmune disease you both shared.  But my opinions are just a product of my experiences, and we all know what body part opinions are like.  (Here’s a hint: I lost mine when they gave me my ostomy bag as a teenager.)   But I can still dream of that day in the very distant future when $1 trillion a year will go to the children and the sick instead of the voter.

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Matt Haarington, MPH, MSHI is an advisor on public policy and health care issues for Social Justice Solutions.  He is the author of The Spider and the Wasp, which is the funniest book you’ll ever read about being traumatized.