The Free Market and The Poor

Close up of female African American doctor holding patient’s hand

I have written in the past about the issue of the poor in the free market, and after a rather long thread of discussion on Twitter last Friday, I believe that it is time to revisit this subject, because I do not feel like those with low incomes need to be left out of the free market movement for health care or kept from receiving the care they need.

One woman on the aforementioned thread made a very unfair accusation against those of us who were advocating for Direct Primary Care practices and the legal availability of true catastrophic health insurance coverage. Such an accusation suggests that those of us who believe in the free market have no compassion for those who are less fortunate than ourselves. This woman, who I will not name, said the following:

“I’m just not cool with a plan that basically gives the low income workers the medical equivalent of “Are there no prisons? Are there no workhouses?” Some of you are and that’s okay. We don’t have to agree.”

Talk about snide!

Sadly, there will always be unreformed Ebenezer Scrooge’s among us, and I don’t like misers like that. There are many of us, however, who believe that the government’s current form of “helping” low-income people is not cutting it because it has created an attitude of entitlement among many people.  The goal should be to help people with certain needs when they are going through a rough time in their lives, not to keep them “on the dole” throughout their lives unless they are permanently disabled or very incurably ill in some way. Obviously those who are most helpless in our society should benefit from a safety net.

One of the comments I made in the aforementioned Twitter debate was that I have had times in my life when I was uninsured and had a medical need while also having a rather low income at the time. Knowing that I was responsible for the bill but that I could not pay it all off immediately, I made arrangements for a low monthly payment until I could pay it all off, which I did. I endured insults from the billing clerk about being a welfare case, but I eventually paid that entire bill off out of my own income.

I understand that there is often a gap between people who can be covered by Medicaid because they are at, or well below, the established poverty line, and those who just have incomes that barely make it in today’s economy but do not qualify for Medicaid. Been there, done that.

One other point I made was that Indiana has a health plan that the state received a waiver from the Obama Administration to implement. It covers adults who are at or near the poverty level, and has a very fresh approach – the freedom for these Medicaid recipients to make health care choices for themselves. An article about this program is entitled “Healthy Indiana 2.0 Is Challenging Medicaid Norms.”

This article details a plan in which able-bodied adults that do not usually meet Medicaid requirements can participate in this forward-thinking Medicaid plan. It provides Health Savings Account dollars in the amount of $2,500, along with a High Deductible Health Plan (HDHP), with the deductible being in the same amount of the HSA. This also gives these Medicaid beneficiaries the opportunity to learn how to be good stewards of their health care dollars.

Additionally, the beneficiaries on the Healthy Indiana 2.0 program are expected to contribute a small amount to their HSA, something like 2 percent of their income, certainly not something that would break the bank. Such a policy gives low-income people a chance to get quality care THEY choose without being subject to a low number of doctors who accept Medicaid, and they have “skin in the game,” which hopefully motivates them to manage their health care dollars wisely by “shopping around” for doctors that can fit their HSA budget, and who have a reputation of being high-quality.

I have seen other suggestions as well, such as providing low-income working people with the money or an automatic monthly membership payment to participate in a Direct Primary Care practice where all their routine care needs can be met, and that assistance could be coupled with being provided a catastrophic insurance plan at very little or no cost to them.

To conclude, I feel that that the free market in health care can be helpful to low-income people, and give them a “leg-up” in health and stewardship of their resources. Those of us who sincerely believe in the free market truly do want everyone to get the medical and/or surgical care they need in a way that is affordable for them. That’s certainly the way I feel, and I know that many people who share my views about free market health care have indicated they feel the same way.

Truly, where there’s a will, there really is a way!


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