What is your proposal to “significantly improve the condition of the poorest of the poor”?
I’m not a politician, so it is not my function or occupation to devise precise plans to incorporate into legislation. I could probably go on all day, but here are a few things.
I would most definitely do away with obamacare, because it adds people who have at least some resources to a Medicaid system that can barely take care of those who have none. Additionally, it threatens to impoverish additional numbers through job loss or truncation.
Short of that, one thing I would definitely do is alter the reimbursement balance between “well care” and “chronic care”. I realize the increased reimbursement for “well care” has some theoretical basis for it. If people don’t get sick in the first place, they won’t burden the system later, right? That’s the thought. But it’s really not empirically based, and at least one study recently appears to establish that 'well care" does not affect ultimate outcomes at all. On the other hand, reducing reimbursement for care of patients with chronic conditions is, to me, indefensible. Medical care ought to primarily be for the sick, not for the well. I would actually raise reimbursement for chronic care.
Unlikely as it will ever be to be adopted, I would “reinvent” institutional care for the terribly mentally ill, many of whom now roam the streets or otherwise live in appalling conditions. It’s expensive, particularly if done in a more “modern” way and with adequate staffing. But it’s also more humane. Obviously, this would require the cooperation of lawmakers and the judiciary, who seem to have a greater regard for “personal freedom” of such people than their otherwise applicable condition warrants.
I would provide grants to the kind of “orphanage” in which i once worked. There were a few true “orphans” there, but most were boys whose parents placed them there because they could not provide adequate supervision, nutrition, home situations or education for their children. Parents could visit their children there and the boys could have home visits. It was a Catholic institution, and worked very well. “Graduates” of the home could, and did, continue to live and work there while pursuing higher education, acting as supervisors and mentors to the younger boys. It closed when the State would no longer refer boys there due to the State’s incomprehensible worship of foster care and the bureaucracy’s desire to expand. Again, there would be a lot of opponents to this kind of arrangement. Interestingly, the one in which I worked was entirely supported by donated funds. But starting such institutions up again would probably require public funding.
I would most definitely provide grants for religious orders like this.
www.sistersoflife.org. They work in slum neighborhoods to persuade pregnant women to avoid abortion, provide them housing and medical services if needed, and aid them in obtaining training and jobs.
They also provide counseling for post-abortion trauma to those who have had abortions.
The current administration would fight this tooth and nail, but we’re talking “should” here, aren’t we?
I would greatly raise the benefits under SSI; currently just over $600/month. I realize a patchwork of state and federal programs can and often do supplement that benefit in non-cash ways. But that’s a hit and miss proposition and adds to bureaucratic costs. I would also actually add a public or program advocate to SSI and SSD hearings. Nobody represents the public interest in those hearings. I strongly believe considerable money could be saved by those systems if that was done; money that could be provided to those in true need. I would give the public advocates access to investigative personnel and require review periodically that is more than just “paper review” as at present.
As an additional means of raising money, I would make SS retirement, Medicare and SSD “means tested”. There is no justification to paying SS to Warren Buffett while people with nothing have to make do on $600/month. None.
Also to raise money, I would prohibit any greater dipping than “double dipping” into any federal and/or state and/or local governmental pension or disability program or combination, and would provide generous “caps” even for “double dippers”. I have, in my time, met triple and quadruple dippers into the public trough who draw from unfunded programs and are wealthy besides.
I would encourage employment by a number of means. But this is already too long, so I’ll stop here.
