I've Been Thinking

Dear Friends and Family,

Books make me think. And, sometimes, my thoughts make me think more. And, sometimes that helps me to reaffirm my beliefs and assumptions about life. And, sometimes that makes me question myself more.

And, that's what I've been doing recently. I've considered myself more liberal than not. And, my social agenda is still more liberal than not. I'm pro-choice. I'm pro gay marriage. I'm anti-gun. I'm okay with all of that.

But, recently I've begun thinking about our social services and the network externalities they engender. On the one hand, pre-natal care for pregnant women sounds like a no-brainer. But, if a woman who doesn't have access to care when not pregnant decides to get pregnant to get care, well, that doesn't seem quite right. I'm not saying it's a logical choice, but I can see people making that choice. Just as an example.

And, so on down the list. When we provide a safety net, which I believe we should, then the choices people are making take that safety net into account and change the math on what the best choice of action is. It can't not.

I don't think we should remove the safety net, but I do think we should rethink how we take into account how the safety net changes behaviors which seem, on the surface, like unintended consequences.

For instance, I was stunned to find out approximately 1 in 6 people in the US are on Medicaid. That's a lot of people. Okay, in a hypothetical world, let's say you get lots of groups of 6 people together - not random people, people.

Some groups will have 0 people on Medicaid and no one close to eligibility. It doesn't even enter into their calculus of life. Some groups will have 6 people on Medicaid and there's a whole monologue worth discussing about that. And, some groups will have 1 or 2 or 3 or 4 or 5 participants. Fair?

I can see the group with 1 participant, in these non-random groups, having the motivation and help to use it as a potentially temporary safety net. I can see the groups of 2 and 3 having lots of meaningful discussion. I can see the groups of 4 and 5 potentially convincing and/or educating the rest of the group on their calculus.

Why not? It happens on so many other topics.

And, that's where I get to thinking. I don't want Medicaid to be a 1 in 6 program. I want it to be a 1 in 20 program. Why? I don't know. But, that doesn't mean I want to just kick all of the extra people out of the program. I want them to have a meaningful way to work their way out of the program. I want the math to have the right incentive structure to get to 1 in 20 without other perverse network externalities.

Sounds like I'll be doing more thinking.


Cheers!
mouse