I’m stunned by the recent study of a Medicaid lottery in Oregon, which I’ll assume you’re already familiar with, but check Seth Mandel at COMMENTARY for a good roundup. The finding that expanding Medicaid at the margin (as Tyler reminds us) is ineffective at promoting health. And as the WSJ notes, this just means that if Medicaid were a new drug, it would not get approved by the FDA. So, how is the self-anointed science-based community going to react?
I come from a proudly liberal family, at least on the Kane side. Grandpa Kane was an elected Democrat, inspired by FDR in the 1930s, and went on to serve in Michigan politics for decades. And as my friends know, he was my hero. To this day, I am driven by liberal instincts to cure poverty, seek social justice, and spread liberty to the oppressed. But year after year, I’ve been disenchanted with the party the calls itself liberal. There are more idealistic young intellectuals in the D party, to be sure, but I wonder how honestly they reflect on the empirical impact of the policies their party supports. To wit, do minimum wages really help the poor or do they suppress low-wage competition & put rural areas at a competitive disadvantage to cities? But I guess that is beside the point. The point today is whether genuine liberals will recognize the limits of state paternalism as designed in programs like Medicaid.
The first test a welfare program should be able to pass is that the program prove more effective than a simple, direct cash transfer. If not, then it is essentially robbing the poor. Why give bread if cash would feed more poor kids? Why give Medicaid if cash would heal more children? Real liberals should think more carefully, more scientifically, as they reflect.