Government is Not a Business: Understanding the Distinctive Roles
Collaboration, active listening, human center problem solving, empathy, compassion, engagement are all crisp, active verbs associated with patient advocacy. They are designed to elevate the healthcare conversation beyond a confrontational, us vs them mentality. After all, solutions cannot happen without honest and open ideation. This post isn’t about creating an environment of ideation or collaboration. Just the opposite, I’m here to scream as loud as I possibly can: Government is NOT a business, let me repeat that for those in the back, is NOT a business so quit comparing it to one.
Why am I screaming this you ask? Medicaid funding. To many people are comparing the continued increase in Medicaid budgets to a business’s mandate to control expenses. It’s a stupid analogy that does nothing except hurt those, usually kids, who need help the most. These are not people who can pull themselves up by their bootstraps, mainly because they don’t have any boots to pull on.
Before I go any further, lets discuss Medicaid’s origins.
As part of the Social Security Amendments of 1965, Medicaid was born on July 30th, 1965. These amendments were signed into law by President Lyndon B. Johnson and introduced significant changes to the American healthcare system. The aim of Medicaid was to expand healthcare access to low-income individuals and families.
The main reasons for creating Medicaid were:
Healthcare Access for the Vulnerable: One of the primary motivations behind creating Medicaid was to provide healthcare coverage for individuals and families who were unable to afford private health insurance and who fell below a certain income threshold. Medicaid aimed to address the healthcare disparities faced by low-income individuals and to ensure that they could access necessary medical services.
Assistance for States: Medicaid was established as a federal-state partnership program. The federal government provides funding to states to help them provide healthcare coverage to eligible populations. The federal funding is determined by a formula that considers the state's per capita income. This structure helps states expand healthcare access without placing an excessive financial burden on their budgets.
Reduction of Health Inequalities: Medicaid's creation was part of a larger effort to reduce disparities in healthcare access and health outcomes among different socioeconomic groups. By providing healthcare coverage to low-income individuals and families, Medicaid aimed to improve the health and well-being of those who had previously been marginalized due to their financial circumstances.
Preventive Care and Early Intervention: Medicaid was designed to include coverage for preventive care services, which can help catch health issues early and prevent them from becoming more serious and costly down the line. This approach not only benefits individuals but also contributes to overall public health.
Long-Term Care Services: Medicaid also plays a crucial role in covering long-term care services. Examples include nursing home care and home-based care for elderly individuals and people with disabilities who meet the eligibility criteria.
Overall, Medicaid was created to address the healthcare needs of vulnerable populations, improve health outcomes, and create a safety net for individuals and families who would otherwise struggle to access essential medical services due to financial constraints. To put it another way, Medicaid was created to provide those who were left behind or to sick for business to consider as a potential customer. It was designed to be a payor of last resort so those in the most need with little to no resources are not forgotten about.
Who are Medicaid’s members?
The geographical and economic makeup of individuals on Medicaid can vary based on factors such as state policies, demographics, and economic conditions. However, there are some general trends that can provide insights into the characteristics of Medicaid beneficiaries:
Geographical Makeup: Medicaid is a federal-state partnership program, which means that the program is implemented and administered by individual states within certain federal guidelines. As a result, the geographical makeup of Medicaid beneficiaries can differ significantly from state to state. Some states have a larger proportion of their population enrolled in Medicaid, while others have a smaller percentage.
States with higher rates of Medicaid enrollment often have a higher proportion of low-income individuals, immigrants, and rural residents. Urban areas may also have significant Medicaid populations, especially in states with large urban centers and diverse populations.
Economic Makeup: Medicaid primarily serves low-income individuals and families who meet specific eligibility criteria set by each state. These eligibility criteria often include income thresholds that vary by household size and other factors. The economic makeup of Medicaid beneficiaries generally includes:
Low-Income Individuals and Families: Medicaid is intended to provide healthcare coverage to individuals and families with limited financial resources. This includes people living at or below the federal poverty level, which varies based on household size.
Children: A significant portion of Medicaid beneficiaries are children from low-income families. Medicaid has historically played a crucial role in ensuring that children have access to necessary healthcare services.
Pregnant Women: Medicaid provides coverage for pregnant women who meet the eligibility criteria, ensuring that they have access to prenatal care and other necessary medical services during pregnancy.
Adults: Many states have expanded Medicaid under the Affordable Care Act (ACA) to cover low-income adults who previously did not qualify for the program. This expansion aimed to bridge the coverage gap for adults who were not eligible for traditional Medicaid but could not afford private health insurance.
Elderly and Disabled Individuals: Medicaid also covers a significant portion of long-term care services for elderly individuals and people with disabilities who require assistance with activities of daily living.
It's important to note that the economic makeup of Medicaid beneficiaries can change based on economic conditions, policy changes, and shifts in demographics. For the most up-to-date and specific information about the geographical and economic makeup of Medicaid beneficiaries, it's recommended to refer to state-specific Medicaid enrollment and demographic data published by government agencies or research organizations.
Now that we have a better understanding of Medicaid it’s time to ask and consider what is the purpose of government? Contrary to one might think, there is a simple answer.
At its core, government serves several fundamental purposes that are generally recognized across different types of systems:
Protection and Security: One of the primary purposes of government is to provide protection and security for its citizens. This includes safeguarding the nation's borders, maintaining law and order, and protecting individuals and communities from external threats and internal conflicts.
Maintenance of Rule of Law: Governments establish and enforce laws and regulations that govern the behavior of individuals and institutions within society. The rule of law ensures that everyone is treated fairly and equally under the law, and it helps maintain social order and justice.
Public Services and Infrastructure: Governments provide essential public services and infrastructure that are necessary for the functioning of society. This includes areas such as education, healthcare, and public transportation.
For comparison, what is the purpose of business?
The purpose of a business is to create value for its stakeholders by producing and offering goods or services that meet the needs and wants of customers. This value creation is achieved through various activities and interactions within the business ecosystem. While the primary objective of most businesses is to generate profit, modern business philosophies also recognize broader purposes that go beyond just financial gains. Here are some key aspects of the purpose of business:
Value Creation: The central purpose of a business is to create value for its customers. This involves developing products or services that address specific problems, fulfill needs, or enhance the quality of life for consumers.
Customer Satisfaction: Businesses strive to satisfy their customers by providing high-quality products, excellent customer service, and positive experiences. Satisfied customers are more likely to become loyal and repeat buyers.
Innovation: Businesses often seek to innovate by developing new products, services, or processes that can lead to competitive advantages and meet changing consumer demands.
Profit Generation: Generating profit is a fundamental goal for businesses, as it enables sustainability, growth, and investment in further value creation. Profit allows businesses to reinvest in research, development, marketing, and expansion.
Job Creation: Businesses contribute to the economy by providing employment opportunities for individuals, which in turn supports local communities and economic growth.
Wealth Creation: By generating profit and providing value, businesses can contribute to the creation of wealth for their owners, shareholders, and investors.
So why is it dumb to examine Medicaid like a business. First, the government is not in the business of creating profit. If it were, our military would only protect those with means, only the rich could afford to drive on our roads, and only the wealthy would get clean water out of their facets. In addition, only those with cash would be educated. We could not function as a country if that were the case.
Kids, pregnant women, disabled, and grandma and grandpa on Medicaid don’t have the resources for new products, services, or processes. If their healthcare is based on the size of one’s checkbook, then they are in serious trouble. These people need a big brother with medical expertise and a willingness to share. They are humans, not a commodity for profit.
Even if you consider taxpayers to be “shareholders, government to be the “business” entity, then cutting business expenses would mean eliminating access to life saving resources to fellow humans in need. Medicaid officials could choose to provide healthcare access to kids and pregnant women, but the disabled and grandma are left to fend for themselves for example. Again, these are fellow human beings without any bootstraps to pull, they are not a commodity for profit.
Your taxes are too high, so are mine. That’s not the point. Government is good at collecting money and redistributing it. However, we take pride when the Department of Defense takes an extra $50 billion over their budget request or when Chevron takes a hundred-million-dollar tax benefit even though they only owe ninety million yet somehow a pregnant woman on Medicaid is a government moocher. An adult making $22K a year who receives a cancer diagnosis is a freeloader for applying to Medicaid yet the orange one is celebrated for attempting to write off a billion dollars in business expenses despite claiming to be worth several billion.
Business is cool, thanks to business I’m creating this post on an insanely cool laptop while hoping my phone will ring with a dream job offer while drinking a flavored coffee. Not one of these things, not one, was created with the hope of making my quality of life better. It was all created for the soul purpose of taking money out of my wallet and putting it into a business wallet. By contrast, Medicaid members are fellow humans who don’t have the financial resources for essentials like good food, laptops, or access to quality healthcare. They don’t care about laptops or flavored coffee; they need protection and care just like the Department of Defense or the orange one gets from our system. Business purpose is to generate value and profits, governments purpose is to bring everyone together so no one, NO ONE, is left behind.
P.S. Much of this post was created with help from AI.
