Welfare Reform: A Matter Of Justice Essay, Research Paper
Welfare Reform: A Matter of Justice
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.