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Don't expand Medicaid and its broken ways

Don't expand Medicaid and its broken ways

Idaho Freedom Foundation staff
February 23, 2015
Idaho Freedom Foundation staff
Author Image
February 23, 2015

By James L. Payne

It’s curious to watch as big-government foot soldiers simultaneously blast broken state-run programs and ask for even bigger state-run programs.

There’s little sense in the thing, but that’s what’s happening during Idaho’s Medicaid expansion debate.

The headline of the report by Boise State Public Radio I just noticed runs, “Medicaid Payment Woes Plague Idaho Mental Health Providers.”

We hardly need reporters to tell us about the cumbersome and exasperating way the welfare state functions. It’s a fact of life.

Lately, I’ve been asking my liberal friends this question: “Is government an efficient and responsible problem-solving machine?” The answers range from derisive guffaws to sad, pensive comments like, “Well maybe it ought to be, but it certainly isn’t now.”

Not one of them gives a straightforward, confident “Yes.” They’ve been through too many Veterans Administration crashes and Obamacare rollouts.

Isn’t this strange? Our experience tells us that government is riddled with inefficiency and favoritism, yet we keep expanding government’s scope. The explanation for this contradiction, I believe, is people tend to have an unconscious attachment to government in spite of its known failings. This loyalty resembles a state of codependency: People keep wanting what they know is dysfunctional.

Perhaps there exists a way to start overcoming this unwholesome attachment. Instead of debating the specific pros and cons of each new expansion of government -- now the status quo -- we should be reminded of the assumption being made about well-intentioned entitlements.

Whenever a politician urges another program, he should explicitly declare his confidence in government as a problem-solving machine.  Expecting them to include this “Declaration of Confidence” is only logical. Someone who believes that government is dim-witted, irresponsible or corrupt shouldn’t argue for giving it more responsibility. Should he?

A prime case study: under the Affordable Care Act, the federal government offers Idaho and other states significant fiscal incentives to add more people to Medicaid. Should Idaho go along?

Instead of politicians just saying, “Sure, let’s expand Medicaid to help more people,” we should ask those who support this expansion to explain the assumption that underlies it. They should word their position thusly: “Because government is an efficient and responsible problem-solving machine, I think we should increase its role in subsidizing medical care.”

My guess is that most politicians would gag at making this kind of statement. And if they did make it, I think most voters would giggle.

It’s time we stopped hiding behind euphemisms and good intentions as enlarge clumsy big government programs.

We need to bring into the open what we know about government’s limits and failings.

James L. Payne has taught political science at Yale, Wesleyan, Johns Hopkins, and Texas A&M. His books on public policy include Costly Returns (1994), Overcoming Welfare (1998), Six Political Illusions (2010) and Take Me to Your Government (2013).

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