Med­i­caid col­umn hits a raw nerve

The Washington Post Sunday - - BUSINESS - MICHELLE SIN­GLE­TARY Writes Sin­gle­tary at The Wash­ing­ton Post, 1301 K St. NW, Wash­ing­ton, D.C. 20071 or sin­gle­tarym@wash­ To read more, go to­gle­tary.

I spoke can­didly about the need for Med­i­caid. And the haters at­tacked.

The Repub­li­can ef­fort to over­haul the Af­ford­able Care Act in­cludes a ma­jor ad­min­is­tra­tive shift in the health in­sur­ance pro­gram for the poor. Fed­eral funds for Med­i­caid would be capped, putting the onus on states to fig­ure out how to cover peo­ple who can’t af­ford health care.

As some­one who was on Med­i­caid as a child, I fear for peo­ple who might suf­fer with­out ac­cess to health care. With­out Med­i­caid, I wouldn’t have got­ten treat­ment for a de­bil­i­tat­ing ill­ness. My brother Mitchell, who suf­fered ter­ri­bly with epilepsy, wouldn’t have re­ceived the med­i­cal at­ten­tion he needed.

I thought my ex­pe­ri­ence, which I dis­cussed in a re­cent col­umn, might help peo­ple bet­ter un­der­stand the face of poverty. There are many fam­i­lies who work hard and still can’t af­ford health care.

And yes, there are also peo­ple who make mon­u­men­tally bad de­ci­sions that re­sult in their need for as­sis­tance. But

$7.40 per $1,000; 2.42% yield $1=111.21 yen, euro=$1.08

should we aban­don them?

For some, judg­ing by the feed­back I re­ceived, the an­swer is yes.

“Since you teach and preach per­sonal re­spon­si­bil­ity, I urge you to [en­dorse] ge­netic test­ing,” a Vir­ginia man wrote. “Your brother Mitchell should never have been con­ceived.”

Some read­ers wanted to know why my four sib­lings and I ended up liv­ing with my grand­mother Big Mama, as if there should be a moral test to de­ter­mine if we de­served aid.

I did not share that part of our story be­cause it shouldn’t mat­ter.

Do we re­ally want a gov­ern­ment that seeks to sup­port only those peo­ple whom politi­cians deem wor­thy of as­sis­tance? Do we want to with­hold health in­sur­ance from needy chil­dren un­til some bu­reau­crat makes an assess­ment of wor­thi­ness and checks a box?

If some par­ents — bro­ken peo­ple for what­ever rea­son — act ir­re­spon­si­bly, does that mean they should be dis­qual­i­fied from ever re­ceiv­ing aid? Should their chil­dren not be able to see a doc­tor or get medicine? Should the whole fam­ily be forced to en­dure a life of mis­ery?

“Your opin­ions about Med­i­caid are not shared by ev­ery­one,” an­other reader wrote, “and although I am glad that you and your sib­lings were helped by this pro­gram, there are many hard-work­ing peo­ple out there that are pay­ing to sup­port those who are care­less in their de­ci­sions about hav­ing chil­dren in the first place and then ex­pect­ing the gov­ern­ment to take care of th­ese chil­dren.”

And then there was the fol­low­ing email, most of which isn’t fit to print and which con­tained sev­eral uses of the nword: “I see in your ar­ti­cle about your child­hood. Poor . . . blah, blah, blah. What makes you think white Amer­ica is go­ing to keep foot­ing the bill for you [ex­ple­tives]?”

Part of me loathes giv­ing a plat­form to such ha­tred and racism. But that which we fail to re­veal lives and grows in dark­ness.

I un­der­stand all too well the pathol­ogy of poverty. I don’t ex­cuse those who make life choices that re­sult in oth­ers hav­ing to pick up the pieces. I was one of those pieces.

Yet, we can’t af­ford to leave mil­lions of peo­ple with­out a safety net. If not out of com­pas­sion, at least rec­og­nize that when you pull peo­ple up, we are all lifted.

Healthy peo­ple are more pro­duc­tive — able to work and pay taxes. There is also an enor­mous cost to deny­ing peo­ple care. Pre­ventable med­i­cal con­di­tions that go un­treated ul­ti­mately re­sult in even greater so­cial cost.

Amid the ug­li­ness and judg­ment were folks who of­fered a more char­i­ta­ble view.

One reader wrote: “Peo­ple who have never ex­pe­ri­enced se­vere health prob­lems have no idea how hard it is to lead a pro­duc­tive life, much less de­ter­mine how to pay heinously ex­pen­sive med­i­ca­tion and doc­tor-visit costs. If only they could walk a mile in those shoes, they would be as re­pulsed as many peo­ple are that Med­i­caid is be­ing blamed for the na­tional debt.”

Paul, a teacher in Fair­fax, Va., has a brother with Down syn­drome. His mother re­ceived help after de­vel­op­ing Alzheimer’s.

“I have tears in my eyes think­ing where my fam­ily would have been with­out some as­sis­tance from gov­ern­ment,” he wrote. “But the tears are also from grow­ing up in a time when peo­ple were cal­lous or cruel to those less for­tu­nate. I thought ig­no­rance and lack of care to­ward the most vul­ner­a­ble were in the coun­try’s rearview mir­ror.”

We have come to a cross­roads where the de­sire by some to bal­ance the fed­eral bud­get and re­duce the deficit could have the ef­fect of down­siz­ing the care for our pop­u­la­tion’s most needy.

There is no doubt that we have to con­trol gov­ern­ment spend­ing. Just like with your house­hold bud­get, you can’t for­ever sus­tain spend­ing more than you take in.

But we also have to bal­ance fis­cal re­spon­si­bil­ity with the moral obli­ga­tion to help our na­tion’s most vul­ner­a­ble.

Michelle Sin­gle­tary THE COLOR OF MONEY

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