It Takes a Nation

Rating:
Summary: She's never been a Medicaid eligibility worker
Review: I'm a Medicaid eligibility worker in the USA. I don't have textbook knowledge of Medicaid; I work "in the trenches" and see what really happens, instead of what was intended to happen.

The programs that I do eligibility for include SOBRA Medicaid, which covers children and pregnant women, and Medicaid for Low Income Families (MLIF), which covers families with children under the age of 19.

The majority of the pregnant women I see are unmarried; that is beyond dispute. But it's not all black women; I see a great number of white women too. I have worked in several different counties in my state, and I have over eight years of experience.

Yes, it is true that some people end up without health insurance because they lost their job due to "downsizing" or "outsourcing."
But there are also a lot of people who continue to produce more children that they (allegedly) can't afford to pay for. And most of these children are born outside of marriage, the ultimate committed relationship.

The worst program is MLIF, which replaced Aid to Families with Dependent Children (AFDC) in 1996. It penalizes people for working, and it encourages people not to work. The income limit is so low that it's very unlikely anybody who's employed will qualify.

Also, the programs I do eligibility for don't allow us to verify the person's assets. In other words, we can't ask them what kind of car they drive, what kind of house they live in, what property they own, how much they have invested in the stock market, etc. This is in contrast to the nursing home Medicaid, which requires applicants to disclose ALL their assets. People frequently have to sell their homes and spend all of the proceeds until their net worth is less than $2000 before they qualify for nursing home Medicaid.

It's really frustrating when I have to deny pregnancy coverage to a woman who is working, or whose husband is working, and award somebody who doesn't work at all. Of course, there are many pregnant applicants who do work, and I readily concede that. But some of these women could afford to work out a payment plan with a doctor if they really wanted to.

Also, I have had cases where the pregnant woman (girl in some cases) lives with her parents, but we can't count their income. There was one particularly outrageous case where the pregnant applicant was living with her parents, and both were making really good money. Why shouldn't they have to pay for their daughter's care? Why should taxpayers have to foot the bill?

The vast decline in the belief in personal responsibility seems to go back to the sixties, when Medicaid and other social programs came out. (Social Security dates back to the thirties).

There's no preset limit on how many people can qualify for Medicaid, but there should be. We have finite resources, and spending on domestic programs really tests them. And we need to put a limit on how many times a person can receive subsidized prenatal care. If you don't have enough money to pay for the pregnancy and delivery, you have no business making babies. And this goes for the men,too. I know there are plenty of men who are total dogs, and they've created enough illegitimate babies to populate a small country.

One of the worst things about these programs is that it punishes people for getting married. If a pregnant woman applies for Medicaid coverage, and the father of the unborn lives in the home with her (and she actually tells us this), we can't count his income unless they're married. That's totally outrageous.

It's fine if you disagree with my viewpoints. But you have to ask yourself, if you've never been a Medicaid eligibility worker, if your opinions are based on actual observations instead of political rhetoric.

Rating:
Summary: Comprehensive new anti-poverty agenda
Review: In a recent issue of Radical Middle, a newsletter published by Mark Satin, the lead article was entitled "Left, right and evangelicals hammer our holistic anti-poverty agenda". This book was one of three that was most highly recommended.

"Today, for the first time in three decades, comprehensive new anti-poverty agendas are being proposed by prominent scholars and civic leaders. And they're about as different from the "entitlements"-based agendas of the Sixties as can be imagined.

"They're infinitely more sensitive to the totality of the problems of the poor.

"They involve a lot more entities than the Federal government.

"They're more supervisory (some might say "paternalistic" or "maternalistic"), but at the same time less bureaucratic, more responsive to individual poor people's unique situations.

"And they're not just coming from one end of the political spectrum! OF the three most promising agendas from the last three years, one is from a leading radical-liberal scholar, Rebecca M. Blank, former director of the Joint Center for Poverty Research at Northwestern University (this book)

"Another is from a leading conservative scholar, Lawrence M Mead -- one of the token conservatives at New York University -- working in colloaboration with the Brookiings Institution (Mead, ed., The New Paternalism: Supervisory Approaches to Poverty, 1997)

"And the third is from a thrologian whose politics can best be described as "radical middle" -- Ronald J. Sider, President of Evangelicals for Social Action. Sider, who's lived, taught, and ministered in poor and working class neighborhoods in Philadelphia for 30 years, got former Nixon aide Chuck Colson to write a foreword to the agenda. (Just Generosity: A New Vision for Overcoming Poverty in America, 1999)"

-- from Radical Middle, Center for Visionary Law, Business and Public Policy, Inc. PO Box 57100 Washington, DC

Rating:
Summary: Thought provoking
Review: This is a book that is full of facts. It analyses the studies of poverty that have occurred over the last 30 years. It concludes that a lot of popular views of poverty are wrong. The popular perceptions are that poverty is ghetto based, it is behavioral and untractable. Some groups in America tend to use stereotypes as a means of arguing for the reduction of welfare payments. These include the assertion that a large number of poor people are black single mothers. The decision to become a single mother in a time of freely available birth control and abortion suggests that the mother has made a considered decision to become pregnant.

The book examines the nature of poverty. The material is statistical but it breaks down a number of stereotypes. Poverty is far more diverse with poor people living in a range of settings and neighborhoods. A high percentage of the poor work poverty is due to a range of factors. The inability to obtain employment, the dependence on part time employment or factors which prevent the ability to obtain an income such as age or having the sole responsibility for raising children. Some social programs have been successful in reducing poverty amongst the aged.

In previous years it has been thought that economic growth has decreased poverty. This certainly was the case after the second world war and in the 1960's. The reason for this was the combination of increased work hours and an increase in wages at all levels. Since 1988 however this has not occurred. Poverty has increased despite economic growth. The reason for that is the decline in wage levels and availability of the jobs usually occupied by the poor. In 1994 the unemployment rate for people with a University qualification was 3% the rate for high school drop outs was 14% and for Afro American high school drop outs was 20%. Between 1979 and 1993 the wages for high school drop outs decreased by 22%. The situation is however worse for women who earn about 75% of what an unskilled male would earn. The problem of poverty is thus something which will be likely to occur despite what happens in the general economy.

The writer indicates that the amount spent on welfare by the Federal Government is low about 8% of the budget with Medicare contributing another 6%. These programs have been at a stable level since the 1980's. America spends far less on welfare than countries of comparative wealth. The author speculates that this is due to the nature of American history. The groups that have been poor have been recent immigrant arrivals or Afro-Americans. Rather than empathizing with such groups the broad population usually thinks that the problems of poverty relate to issues of laziness or other aspects relating to the different culture of the most recently arrived group.

An examination of the programs to date shows that they are generally reasonably successful and effective. In the 1960's pockets of Americans suffered from actual malnutrition. The food stamp program has solved this problem and the numbers of Americans starving has been reduced. In much the same way giving welfare recipients access to subsidized health care has reduced infant mortality. American programs tend to be more bureaucratic than in other countries and this make their administration more complex but not unduly so.

The author attempts to show that a number of other views of welfare are wrong. She produces statistical evidence to show that welfare payments do not lead to women becoming welfare queens and that most recipients are eager to get back into the work force.

Her main argument is a suggestion that Government assume the role of collecting child support from absent husbands. At the time of writing such support was only undertaken by the women themselves and this led to a low level of payment of support. In other countries the government collection of these payments has made a significant improvement in the welfare of women and children.

The book is readable and it is at all times based on statistical material rather than anecdote. The conclusion is that because of the decline in non skilled wages poverty will be a problem in America for some time regardless of growth. There is no simple solution and a range of solutions must be constructed for what is a complex problem.