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