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.