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Medicaid: Conservatives Get Flexible (Sort Of)




(Norman Rockwell, 1954)

“I remember my Mom’s heartbreak when she could not afford to give my younger brother the treatment he needed when we learned he had a hip disease,” the man said. “It was my Mom – the wife of a WWII veteran — who taught me something I still believe today: This country is the greatest in the world. America’s greatness is largely because of how we value the weakest among us. Quality healthcare services must be accessible and affordable for all – not just those in certain ZIP codes or tax brackets.”

That’s music to the ears of progressives, maybe even Top-40ish in its soothing, harmonious familiarity. The dissonant note is who actually spoke the words: Rick Scott, the Republican governor of Florida, who swept into office on an uncompromising anti-Obama, stop-health-care-reform platform, and was one of the first to sign on to lawsuits challenging the constitutionality of the Affordable Care Act (ACA).

Like other Republican governors, Scott has recently decided to support the expansion of Medicaid, the health insurance program for the poor. Such expansion is one of the main ways the ACA extends health insurance to people who now lack it. Of course, Scott’s pleasing words notwithstanding, no one thinks he’s suddenly had a change of political conviction. Most analysts think swing-state political calculation explains his decision, as it does a similar one by Arizona governor Jan Brewer.

And far from signaling any change in the attitude of American conservatives towards the welfare state, Scott’s policy shift is consistent with a deep continuity in the way conservatives look at the world. The stereotype is that conservatives’ attitudes towards the welfare state are consistently hostile, and based on abstract, market-loving, libertarian principles. The mantra Scott repeated a few years ago when campaigning against health care reform says it well: “choice, competition, accountability and personal responsibility.”

No working political philosophy is exclusively based on abstract ethical principles. If contemporary conservatives’ attitudes toward the welfare state were based primarily on libertarian ideals, Scott’s transformation would be inexplicable and contradictory.

Modern conservatism’s vision of society reveals at least as much about the ideology as do values such as “freedom” and “responsibility.” There are different versions of this conservative social vision, but what’s consistent in them is a view that some people are capable of living according to high standards, like Scott’s disciplined mantra, while others, inherently, are not.

So, for example, Tea Partiers “hold positive views about the government entitlement programs from which they personally benefit – including Social Security and Medicare,” but they think other welfare programs are “corrupted by creating benefits for people who do not contribute.” That’s the conclusion of research by political scientists Vanessa Williamson, Theda Skocpol, and John Coggin. Although Tea Party members virulently oppose the ACA even while depending on Social Security and Medicare, they are not merely hypocrites They are just the latest in a long line of conservatives to embrace a bifurcated, hierarchical vision of society — and to be flexible about how they apply supposedly-uncompromising conservative values to the welfare state.

Right-wing coalitions are constructed less around agreement on abstract ideals and more around status-preserving portrayals of who’s personally responsible and capable of profiting from free choice, and who’s not: hardworking whites versus victim-playing minorities; morally-dependable older generations versus dissolute young people; upstanding natives versus freeloading immigrants – or, in Mitt Romney’s view, the elite of Boca Raton versus the 47 Percent.

The fact that conservatism isn’t inextricably tied to a universally-applied, principled critique of the welfare state means that conservatives have considerable flexibility in taking positions about programs like Medicaid and Social Security.

The most familiar conservative case against Medicaid would be not so much that it threatens Americans’ freedom but rather that it coddles unworthy recipients. But for reasons of political expedience, Scott, Brewer and others have temporarily given up stressing Medicaid as a program for moochers. So what arguments are left for the right? Many, as it turns out.

First, as surprising as it seems, conservatives can choose, rhetorically, to group Medicaid recipients with Tea Partiers who count on Social Security and Medicare – portray them as worthy people who sometimes or in some ways need a bit of help to set them on their feet again for free choice and responsible living. That’s now the approach of many in this group of Republican governors. It follows that it would cruel not to proceed with Medicare expansion. Or as Brewer put it, “the human cost of [such a] tragedy can’t be calculated.”

This argument infuriates other conservatives, hardcore opponents of Medicaid expansion. But the Medicaid-moocher approach is at least temporarily of no use against governors like Brewer and Scott. So what is there to say? How about this: “Medicaid harms the poor.” That’s the claim of an article in the National Review. Of course, there are a number of serious problems with this argument, beginning, most importantly, with the fact that it’s contradicted by common sense and the most reliable research, which shows that “when poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability.” But never mind.

What else have American conservatives got? Die-hards argue that Medicaid expansion will ruin state finances and the health care system. But Brewer has got that one covered. Her advisors now argue that Medicaid expansion will “stabilize the state’s health care system.”

Again, what makes this recent cacophony possible is that conservatives aren’t really consistent, principled foes of welfare provision. Such purist ideologues exist, but their arguments aren’t the main element of the vision that holds the movement together. It’s really all about a shifting boundary between those who are worthy and those who aren’t.

It might seem, then, that the laugh’s on conservatives. Hardly. This kind of flexibility can pay off. First, it keeps Tea Partiers in the fold. And it can be lucrative for some members – or potential members — of the conservative coalition. A number of conservative governors and legislatures like the idea of expanding Medicaid – but not in its traditional form, rather as a subsidy for private insurance schemes. This would probably be more expensive, cover fewer people, and lessen benefits and protections for recipients. But it would be good business for doctors, hospitals, and insurance companies—all presumably on the right side of that Maker v. Moocher divide.

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