Health Exchanges Prove the Dependency Portal Point

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Back when the idea of government-run health insurance exchanges first entered into Rhode Island state government policy, the RI Center for Freedom & Prosperity warned that they were being set up to become “dependency portals“:

The exchange will become a dependency portal when other forms of public assistance — from food stamps to cash-payment welfare to child-care subsidies — are integrated into the system and promoted to the exchange user based on information that he or she provides while seeking health coverage — perhaps automatically enrolling people with the merest expression of consent.

As James Taranto points out, the evidence wasn’t long in arriving upon the exchanges’ unveiling:

… Brendan Mahoney [is] 30 years old, a third-year law student at the University of Connecticut. He’s actually been insured for the past three years … through “a high-deductible, low-premium plan that cost about $39 a month through a UnitedHealthcare subsidiary.” But he wanted to see what ObamaCare had to offer. … Now, he says, “if I get sick, I’ll definitely go to the doctor.” Even better, if he stays healthy, he won’t need to go to a doctor, and his premiums will support chronically ill policyholders on the wrong side of 40.

So, how much of a premium is strapping young Brendan Mahoney paying to help make ObamaCare work? Oops. The Courant reports that Mahoney “said that by filling out the application online, he discovered he was eligible for Medicaid. So, beginning next year, he won’t pay any premium at all.”

Sure, it’s just one anecdote, but a policy sold on bringing healthcare to the uninsured appears to be structurally indistinguishable from a policy designed to push people who are willing and able to take care of themselves into dependence on government.



  • mangeek

    I'd argue that enrolling in services -ought- to be as simple as dialing-in some info into a website, and the website -should- offer -all- available services to those eligible.

    The battle over what the criteria of eligibility should be is a different one to be had.

    Does it really make sense to have government programs that aren't advertised, that only those 'in the know' get access to? Does it make sense to have the indigent filling out paper forms and toting them across town to a whole bunch of different agencies?

    I want my tenants to dial-in their info and get a list of things they're eligible for, from SNAP, to Medicare, to Heating Assistance, legal services, immigration information, etc.

    In addition to that, I want the thing to link to a central database that we call 'Identity Mangement' in the industry. It should tell you if you have any outstanding warrants, let you pay your parking tickets, pay your taxes, update your registration at the DMV, and request a new ID card/Drivers License.

  • It's not surprising that you'd argue that. After all, money is fungible, so any government assistance your tenants get only helps you make money off the investment of your rental property. Me, I'd rather lower the rent that I charge for a particular person, knowing that I'm helping him/her/them to build an independent life.

    In the larger scheme, we're just back around to the difference between a free society and technocracy. Typically, the technocrats want to tell people how to spend money to improve the collective society. In this case, the dependency portal wants to tell people when they need assistance:

    "Hey, Mr. 30-year-old law student, you don't really need to allocate money for healthcare. We've determined that people in your position deserve it for free. Be sure to vote for the candidates who want to keep that subsidy going (and limit freedom) when next you vote."

  • Mike

    Ouch. Has mangeek ever seen a give away program he doesn't embrace? Perhaps when an insolvent government tells him his rents are too high he'll see the light….

  • Dan

    Mangeek – Public assistance should be difficult to obtain, and it should be difficult to maintain eligibility. Categorically speaking, it should be unpleasant to be on welfare, with lots of documentation and requirements to meet each and every week. This properly aligns incentives toward getting people off of assistance rather than encouraging them to stay on or sign up for more assistance than they actually need. We want to discriminate in favor of those who truly need the help, and barriers to entry accomplish that.

    When you are giving public assistance away with low eligibility requirements and essentially no verification in place, you get able-bodied adults who could get a steady job instead living off of others and pursuing their unpaid hobbies, such as – to take a hypothetical example – operating a prominent progressive blog full-time and hanging around the state beaches all day. Unlike piddling social issues, this is the kind of stuff that actually wrecks economies, so Rhode Island should be systematically incentivizing against it.

  • Sheesh, Dan. You make up some far-flung hypotheticals…

  • Mike678

    But when you can take working people's money and give it those who would rather not work in exchange for their votes–all in the name of "fairness"–were is the incentive for our enabling leadership to change?

  • Max D

    Geez Mangeek, you walked right into that 2X4. I hope it didn't leave a mark.

  • mangeek

    "it should be unpleasant to be on welfare, with lots of documentation and requirements to meet each and every week."

    And I'm all for limiting what welfare monies can be used for. It bothers me just as much as it bothers you to see a shopping cart full of soda and potato chips getting paid-for with SNAP, and the parent getting into a nice late-model car in the parking lot. What I'm saying is that by -unifying- the information (remember how I wanted to connect the IRS to the DMV and SNAP?), we can find these cases and fix them.

    I just don't believe that in this world, people are going to 'start acting responsibly' just because their next meal or the roof over their head is on the line. I see it all the time. It works for most of us, which is why I keep working and paying taxes, but there's a fair portion of society that NEEDS their sh*t regulated and their budgeting done for them. I think it's always been that way, but family structures and economics have changed in a way that marginalizes those people.

    We're moving towards a society where only the top 20% have enough income to live The American Dream (and the threshold to the top 20% for a household is $89K/year), and everyone else is just living various shades of subsistence, from the family that only needs the FHA to back their home loan for the first few years, to the paranoid delusional who needs his food, heating, and rent paid-for and managed.

  • Dan

    "What I'm saying is that by -unifying- the information (remember how I wanted to connect the IRS to the DMV and SNAP?), we can find these cases and fix them."

    Yes, absolutely, but the data systems should be unified on the state's end to cross reference who is receiving what from whom and whether they continue to be eligible. Nothing in this principle implies that it should be unified on the user end into a one-stop-shopping center for public assistance. All that does is incentivize people to get onto these programs and stay on. That's great for you and your tenants in the short run, but it sucks for running a healthy economy in which people are achieving maximum productivity.

    "It works for most of us, which is why I keep working and paying taxes, but there's a fair portion of society that NEEDS their sh*t regulated and their budgeting done for them."

    I don't understand from where this "need" is coming. Poor immigrants came over by the millions through Ellis Island in the 1900-1920's and didn't immediately enroll in public assistance. They didn't starve in the streets or keel over and die. They all got jobs – often dirty, difficult jobs – and worked hard to lift themselves out of poverty. The problem today is it's simply more attractive to go on SSDI + food stamps + WIC + public housing and sit around all day than to get a job performing repetitive or unpleasant tasks. This is a huge incentives problem.

    • Russ

      "Yes, absolutely, but the data systems should be unified on the state's end to cross reference who is receiving what from whom and whether they continue to be eligible."

      Yes, because we all know how simple it is to integrate disparate and conflictng eligibility systems/business rules.

  • mangeek

    "…They all got jobs – often dirty, difficult jobs – and worked hard to lift themselves out of poverty."

    You can work full time now and not make enough to pay rent. Back in the Good Old Days, you could put your whole family up on one full-time job.

    A recent example comes to mind: Consider someone who makes $10 an hour and works 40 hours a week, no vacations. Now consider that their work truck (which they pay $350/month for) is broken and needs a transmission. What kind of person who makes $1,700 a month is going to have $2,000 laying around?

    Try getting an unskilled job right now, there just aren't any, and those that do exist pay wages that aren't worthwhile and don't offer any health care.

    The meme that if the government just got out of the way, there would be plenty of growth to employ these people just doesn't seem to hold water. If I get to keep the money the government takes from me now, I'm just going to use it to backfill the giant holes of debt that normal people incur these days.

  • Dan

    Mangeek – The problem with these progressive narratives about how no family below $__k income can supposedly survive in the modern world is they rely on a number of debatable assumptions and accept many costs as fixed that are in fact malleable.

    First of all, if someone is earning minimum wage (and if they're still earning that at age 30-40, something is very wrong), they can earn that pay anywhere, and they have no business living in a highly desirable city area where rents are sky high. When I worked in Boston in 2006, I didn't live right in the city and pay $1600/month; I lived in a craphole in Revere and paid a quarter of that. In college (not that long ago), I lived off campus and paid $200/month for rent. Second, assuming they don't want to live with family, people earning low incomes can find roommates to half, third, or quarter their cost of living, as I did through most of my adult life. Bleeding hearts with an agenda examine rents and utilities as if every individual needs to live by himself when this isn't a responsible assumption at all. I've never in my life had a vehicle repair cost $2000, but even if it did, there are many usable trucks selling on craigslist right now for half that price, and laborers should be carpooling to work anyway, which is what I did when I worked summer construction throughout high school.

    It's amazing how people find ways to live affordably when the things they want stop being subsidized and their actual needs are placed in jeopardy.

  • This is quite an astonishing statement, Mangeek:

    "If I get to keep the money the government takes from me now, I'm just going to use it to backfill the giant holes of debt that normal people incur these days."

    So, people are currently putting themselves in "giant holes" of debt to compensate for economic malaise and the money the government confiscates from them, and that is better than enabling them to live within their own means without accumulating interest rates (while at the same time avoiding massive public debt and interest payments)?

    By the way, I can't think of any of my coworkers who were making $10 an hour and owned vehicles with $350 payments. (If there were any, it's because they didn't need the money for anything else.) Most of them were driving vehicles that weren't worth $2,000 in the first place and were using those vehicles as a stepping stone to be able to do higher-end work or side jobs for themselves.

    That's what I did. For the first two years of carpentry, I drove a broken-down Thunderbird until it could no longer fit the tools I need for side jobs (which at that point were start-to-finish renovations. I then went out and bought a used van to accommodate my needs, which also made me more valuable to my regular-work boss. As he started utilizing my skills and equipment, I was able to demand higher pay.

  • mangeek

    I think you guys are reading me a bit wrong.

    I just don't think the economy of the future is going to allow anything like a middle-class dependence-free lifestyle for a majority of the people. Justin, you and I are -exceptions-, based on what I see in my own life. Most people I know are working hard and getting nowhere, and things like home ownership or retirement are Never Gonna Happen for them, even for many with college degrees.

    The jobs available to them pay low-wages, have unsteady hours, and offer zero benefits. Out of, say, my closest 20 friends, I think two (myself included) are saving for retirement. Our golden years might be in our own homes, but concrete elderly towers for the other 90% are going to dominate the landscape.

    Meh. Maybe I'm just having a bleak day. I'm just putting my own life into perspective. At age 31, I'm just now starting to have a net-worth that's non-negative. I have friends with college degrees who are 30, 40 years old and many are worth -$100,000, applying for jobs serving coffee and making sandwiches. Sure, Rhode Island is a particular bad example of Good Intentions Gone Awry, but on a global scale I see things between our world, the developing world, and the third world all getting closer to each other over time.

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