A common thread among conservative thought regarding social programs (such as Medicaid) is the idea that if we have social programs, the populace will be less inclined to rebel against government tyranny (granted, tyranny has been watered down significantly to include anything that doesn’t gel with Ayn Rand and Jerry Falwell). After all, a population that has government healthcare or anything else will be afraid to speak out against the government for fear of having their lives endangered. A common phrase I’ve heard is “enslavement to government dependency.” We’re told that voluntary charity is better than Medicaid.
Yet with the disability rights movement, we’ve seen none of that. Disabled people are some of the most vocal protesters in America. During the Trumpcare debate, while most of the parent groups were sending stern letters and wagging their fingers, actual disability-rights groups were on the ground. They were putting their bodies on the line to protect Medicaid and pre-existing condition protections. Incidentally, all disabilities are preexisting conditions.
So if Medicaid makes people less rebellious, why are some of the most vocal protesters on Medicaid? Why did the disability rights movement take off after the implementation of Medicaid? Put simply, Medicaid means freedom. A neutral social safety net means being vocal doesn’t cost us.
Sure, there are a lot of issues. Marriage penalties and asset limits are some examples of things that need changing. Those things could be changed by electing people who are pro-Medicaid. Despite these flaws, Medicaid has given disabled people a lot more freedom than they’d have in a voluntarist state. People underestimate the value of a neutral social safety net.
Medicaid gives disabled people freedom of speech
One of the things about voluntary aid is that it tends to go to the people that are most liked. It’s a popularity contest. It’s why the people who tend to get voluntary aid tend to be cute and adorable. St. Jude isn’t putting the less attractive kids on T.V. for a reason.
One of the things about talking about disability rights is that people don’t like to hear it. They don’t like hearing about how their favorite hangout has had nearly three decades to get compliant with the Americans with Disabilities Act and that if the hangout gets sued, it’s the businesses’ own fault. They don’t like hearing that disabled people have the right to access schools, buses, and society at large. In general, able-bodied people can’t take criticism well from the disabled. If you don’t believe me, go to an article about an ADA lawsuit and read the comment section. You’ll find the kind of vitriol that would make a shock jock blush.
In a voluntarist state, disabled people have to shut up. We can’t say anything that able-bodied people don’t like. We can’t criticize things like churches or say anything that makes us unpopular. We certainly can’t show up to protests. If we do, the donors will shut their wallets and it could easily cost us a piece of adaptive equipment. It could even cost us our lives.
Speaking of churches…
Medicaid gives disabled people freedom of religion
If you were disabled pre-Medicaid, and you were lucky enough to live outside an institution, you and your family basically had to rely on the church. You had to base your church selection on who had the most outreach programs that helped you. If you didn’t like what the church was preaching, oh well. If your church was inaccessible, you had to wing it. But you couldn’t dare say anything about the inaccessibility.
You certainly couldn’t be part of the more unpopular religions, either. Atheism was right out. If you needed help, you had to be part of the most popular denomination in your community and even that was no guarantee. Remember that many churches, then and now, can barely keep the lights on. They’re not equipped to handle people with medically complex conditions.
Thanks to Medicaid, we can choose our churches based on what suits our beliefs. We don’t have to base our religion on which church is more likely to have a successful fundraiser if we need a wheelchair. We can even choose to have no religious beliefs. This, in my view, is what animates a lot of opposition to Medicaid/universal healthcare from America’s Evangelical community. Without a poor underclass that needs the church for charity, the church, already bleeding members as it is, is afraid of becoming irrelevant the way it has in European countries with universal healthcare.
Medicaid gives the disabled political freedom
Part of the thing with charity and GoFundMe is that you have to be popular. Not just in the conventional sense (though being physically attractive does help) but you can’t be publicly out of step with your community and disabled in a state that has no social safety net. Without Medicaid, you can’t be a gun-loving Trump supporter in Berkeley. You can’t be a public Bernie Sanders supporter in rural Texas. To do so would cost you if you needed something you couldn’t get through your health insurance.
Thanks to Medicaid, and the social safety net’s neutrality, the disabled are freed from worrying that political tribalism will cost them lifesaving medication, treatment, or durable medical equipment. A person with Down Syndrome can publicly claim membership to a pro-life group in a pro-choice town with no consequences. A person in red rural America who needs a wheelchair doesn’t need to worry that having left-wing views will hurt his chances of getting one.
The value of a neutral social safety net
At the end of the day, Medicaid is about giving disabled people freedom from popularity contests. I’d argue that the politically/religiously neutral social safety is in the top 10 disability rights victories. It doesn’t matter if you’re in the correct church or political party. It doesn’t matter if you’re good looking. It doesn’t matter if you’re an inspirational straight-A student who spends their free time reading to the elderly or if you’re just an average person.
Does that mean that people who I don’t like, such as the people who scream that Medicaid shouldn’t exist until they need it themselves, will benefit? Yes. But it also means that people I do like won’t be subjected to the passions and tribalism of the local populace if they need an operation. Neutrality, whether I like the people it helps or not, is Medicaid’s, and the broader social safety net’s most important feature.