Should the US expand Medicaid to 400% of the Federal Poverty Level


That way, we can provide a basic level of medical coverage not only to the poor but also many working and middle-class folks who may end up in a rather difficult or complicate situation? If not, what solutions, would you rather see instead?

  • Yes
  • No

0 voters


Yes. And introduce healthcare as a civil right. And a lot more I won’t get into. But yes, absolutely.


Yes if they don’t work for a company that provides a decent Heath plan. Working and middle class folks have money takien from their checks to subsidize other peoples’ free health care. It doesn’t seem fair that they have bad coverage or no coverage. Nobody should have to worry if they can get health services or drain their life savings or go deep in debt because of a health emergency.


I give you credit for using the correct term Medicaid as opposed to “Medicare for all” or just “free stuff.”


One common complaint with obamacare is that high deductible plans are considered legally sufficient, even at income levels where actually paying the deductible is not a reasonable expense on the income provided. If nothing else, I’d want a decent health care plan to have a cap on how much money someone has to have remaining after paying health expenses. (Not how much money they have in the bank, to clarify, but that the maximum out of pocket costs subtracted from the person’s income shouldn’t go below a a certain amount.)


I want the federal government to have exactly 0% to do with healthcare or health insurance. If states want to implement something, so be it.


But what about our neighbors in need? Perhaps some charitable funds can help pay for some doctors visits and maybe even some more free clinics, but what about big-ticket items like chemotherapy, dialysis and daily medications? Do you think most people would be better off in a free market and that state and local governments as well as charities and foundations can help with those in need? Granted, if we did go towards a minimized federal government, we could see restructuring of tax codes as states and localities decide to step up and as a smaller state encourages more charitable giving and volunteerism (ideally), but even if it were to play out that way, the transition would be… quite an adjustment.


there is no reason that local governments can’t be involved in welfare for their own residents.

The 1602 Elizabethan Poor Law assigned the responsibility for welfare to the parish of the indigent.


The concern nowadays is bargaining power.

Medical care gets skewed with the free market. There are often few providers for services, and the expense makes it difficult to start a new provider for many cases of specialized care. Usually there is no cheaper option, nor can people choose to do without.

It’s unlike even other necessities such as food or clothing, where there is such variety in things I could eat or wear that if one option does not work, there are many others I could choose. If I needed chemo, it is more likely that there would be one or two places that I could go to, and there wouldn’t be any realistic alternative to chemo.

The practice of medicine itself has also changed dramatically. In eras past, there were few involved treatments that had any particular effectiveness. Most of the sources of modern expense would in times past simply have had to let nature run its course for lack of any effective option. That has vastly increased the expense of medicine simply because we are able to help people that in times past would have died.


The last thing I want as a freedom-loving American is for someone else to be sent to jail because they don’t want to pay for my healthcare. Is there any compassion in the least in a system that forces all to participate? It seems to me nothing less than tyranny of the majority.


400% poverty level is 100k/ year for a family of 4.

I think providing medicaid clinics and county hospitals for someone with that much scratch is just asking for abuse.

Sure, 100,000 doesn’t buy what it might have in the past, but still, putting folks like this into the Welfare system isn’t a good idea in my opinion.

I used to work in welfare administration, food stamps and medicaid. Believe me, Middle Class people aren’t a good fit for the system. They just don’t like to comply and are often a disturbance.


Okay, yes, $100,000 does veer into middle class if not upper middle class territory but there are areas in the country with quite high living costs like California where housing prices appear to be through the roof.

That said, it might be fair to just raise taxes but focus on those in need, the poor and working-class (in my perspective, I think there are moderate-income folks (think working class people) who could use the help but make too much to qualify yet they’re far from comfortable or stable. One could make an argument, that these people were definitely trying to an extent, yet some help could be nice. Maybe something to support economic security, as the richest country of the world, can we not afford that, at least a piece of that?

One experience I had was during my high school years where you had students paying for AP Tests, you had people who couldn’t get fee waivers due to free and reduced lunch and thus had to pay the price, taking multiple classes it ended up adding up. It wasn’t the most pleasant experience. Granted one could also argue that having “skin in the game” provided decent incentive to students and that fees gave students and families an opportunity to better deliberate their options (especially since high school life can seem stressful balancing classes, extracurriculars among the other factors in their lives).


Let me tell you something else.

When I was a young man, I didn’t have good insurance, but then I had good health.

But when I did need to see the doctor, I was a paying customer at a local Mediicaid clinic. The level of care that folks receive is ok, but it isn’t the same as a private medical doctor. Lots of interns and residents, they are quick to give you any test they can, its a different experience that middle class people just aren’t used to. They have a system designed to basically get what fees they can from the government and meeting all of their mandates.

Folks on welfare know about this kind of treatment, the constant changing of the guard for doctors, and they are used to it. The Middle Class just isn’t.


I have mixed feelings on that. Ayn Rand was anti-government on almost everything but she chose Medicare to pay for her surgery.


The solution is for us to stop thinking of medical care as “welfare”. There are tons of government services each and every one of us benefits from (highways, libraries, public education, public safety, etc) and we don’t consider that welfare.

To consider medical care the same as welfare (food stamps, section 8 housing, etc.) does a disservice to all of us. We can do better.


The trouble with this sort of argument is that it could be applied to any government at all. It is the essential and necessary nature of a government that everyone is forced to participate for the benefit of society at large - and that not all of those things will benefit everyone equally.

Now there is certainly an argument to be had that some things are or are not the legitimate business of government. But I think the mere appeal to the fact that it is forced fails, simply because all government involves force on some level. If all humans were willing to live in peace, love, and perfect charity towards each other there would be no need for government - but we all know that won’t happen on this earth.


In many instances I’d agree with you because of the principle of subsidiarity. However when it comes to health I’d argue that the federal level is the lowest level capable of ensuring quality care afforded to all citizens. The last thing we need is 50 states with 50 disparate health systems; imagine the headache to both individuals and businesses in trying to make decisions about relocation, conforming with local law, etc.


The federal government isn’t necessary to make charity work. State and local governments can ultimately be more effective since they only have to manage themselves, not themselves and 49 others.


^^^^^^^ This.

I’m 100% against “take from the rich to give to the poor” philosophy, especially here in the US, but I would be fine with paying more taxes for a service I had access to, regardless of my income. How is it that public schools are free for everyone and healthcare is not? I’ve never been able to wrap my mind around it.


It’s also a question of efficiency: why do we spend roughly twice as much as other developed countries for the same health outcomes? It’s because of our inefficient profit-driven system of care.

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