Oren Cass examines Medicaid’s troubling track record for a column posted at National Review Online.
Because of Medicaid, the safety net feels weaker as it grows heavier, exposing bigger gaps even as it spreads. Bad design and political pressure have allowed this one program to dominate our ever-expanding anti-poverty system. Medicaid now accounts for most of what we spend to aid the poor, even though the program aligns badly with the needs of low-income households and offers stunningly little value for its cost. The opportunity to improve support for the poor without increasing spending by reallocating funds from Medicaid to better uses is great.
This should be an obvious area of bipartisan compromise. While the battle rages over total spending levels, all sides should want to maximize the results each tax dollar produces. Instead, virtue is too often measured by who will write the largest check, and questioning Medicaid is equated with callous indifference to the poor.
As is typically the case with misallocated resources, removing distortions and allowing choice would offer a remedy. If the federal government eliminated the incentives that reward Medicaid spending over other anti-poverty strategies and gave flexibility to states, localities, and even individual households to direct anti-poverty resources, the trillion-dollar safety net could accomplish much more than it does now.
