Medicaid Abuse: The Rich Get Richer

Over at The American Prospect, Matt Yglesias is of course correct in observing that complaints about "waste and fraud" in regard to public programs are generally thinly-veiled attempts to eviscerate the programs themselves. So Matt feels understandably nervous about the political purposes to which this current series in the New York Times about massive fraud in the New York State Medicaid program will be put.

That's a valid concern. Progressives naturally have to defend Medicaid by making the obvious point that you don't abolish an activity just because it's associated with waste. (Otherwise the Pentagon would have been razed decades ago.)

But there's another key point here: As with most government programs, the vast majority of the waste and fraud associated with Medicaid goes to line the pockets of venal private enterprises and professionals--doctors, dentists, hospitals, nursing homes, and so on--not the "undeserving poor" or "welfare queens" that inhabit conservative nightmares. (And as the Times series indicates, one of the reasons New York politicians haven't cracked down on Medicaid fraud is the clout purchased by the health care industry with generous campaign contributions.)

This is yet another reason to be on guard against some all-too-common presumptions peddled by Republicans and more than a few Democrats: that injecting "private enterprise" into any activity increases its efficiency, and that small business people (traditionally described as "decent," "hard-working," and "entrepreneurial") are the backbone of our society.

Medicaid fraud is not about poor people ripping off the taxpayers. It's about doctors and business owners getting rich(er) by plundering a program intended to help the poor. Progressives need to make certain this fact isn't obfuscated.