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The Bootstrap Con: How "You're On Your Own" Was Sold to Keep Us Apart · The Overlap

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Most of us were raised on some version of the same idea.
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You work, you earn what you get,
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and nobody owes you a ride. Pull yourself up by your bootstraps.
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It sounds like advice from a grandfather who fixed his own truck,
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right? In eighteen thirty four,
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a paper called The Workman's Advocate used it to make fun of a guy named Mr Murphy,
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joking that he could now hand himself over the Cumberland River for the
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By the straps of his boots. It was a joke.
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Go ahead and try it. Grab your laces and pull up hard and notice that your body
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stays exactly where it was. Because the phrase was invented
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to describe something that a human body cannot do.
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For most of the eighteen hundreds,
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it got filed next to other absurdities like sitting in a wheelbarrow
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and trying to wheel yourself. Then around 1922,
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the joke turned into a compliment somehow.
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The impossible thing became the standard.
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On july fourth, twenty twenty five it became paperwork.
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Under the law signed that day,
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starting in twenty twenty seven,
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a Medicaid expansion adult between nineteen and sixty four years of age
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has to prove eighty hours a month of work or qualifying activity
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to keep Medicare and Medicaid coverage.
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When Arkansas tried its own version in twenty eighteen,
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More than 95% of the people it targeted were already working or should have been
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exempt. And about 18,000 people lost their coverage anyway.
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In Georgia, the program lawmakers still call the model spent twice
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as much on administration as they did on care.
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So how did a joke about something nobody can do become the test we give
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to a person who needs a doctor?
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And who gets paid to give it?
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Welcome dear listeners. This is the Overlap.
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I'm Will. That's Joshua. Say hi,
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Joshua.
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Hi Joshua.
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There it is.
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And today is about a phrase you've probably heard sometime around the kitchen table,
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or maybe when you're eating one of those life lessons from your parents.
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Phrase that for about ninety years meant,
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Hey, you're describing something impossible.
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That's genius.
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Right, in one line, it's a joke about an impossible act turned into a moral test,
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and that test becomes a Medicaid rule in twenty twenty seven.
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So hopefully by the end of this podcast you'll know what Georgia spent
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on paperwork for every dollar it spent on care,
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and which companies are getting paid to grade that test.
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And you might be wondering at this point why we're telling about talking about
3:01
a 200-year-old joke. But the fact is,
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well, I would say nothing broke this week,
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but I'm not sure how much first all there is left to break,
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~ or that nothing broke. But there would there's nothing urgent that
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we would need to talk about immediately to make you aware of.
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So we're doing it because states are signing these contracts right
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now that build the systems that will check those 80 hours,
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and every six months they'll recheck.
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Right. Georgia is is kind of at the forefront of this,
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right? The goal was twenty five thousand enrollees out of two hundred forty
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six thousand that were eligible.
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So after eighteen months it had about sixty five hundred.
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So I guess we can
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That's
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kind of start with a little bit of a a gut check,
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right?
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Okay.
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What what is your first reaction to this idea,
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this concept, Will?
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This idea that able bodied adults should work for their benefits?
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~ I mean at first it sounds plausible,
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right? I mean it sounds like, well,
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I mean, they're getting something if they can get back,
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they should. But I guess ~ the reality is nobody's in that situation by choice.
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You know, and so I'm not really sure,
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you know, first of all, where does the number eighty hours come from?
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Where where does that become the the line?
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You know, it's it's one of those things that sounds good when vaguely stated,
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but when you actually put it to pavement,
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I'm not sure it may it passes the test.
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Yeah, I I kind of I kind of feel the same.
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I also think i i it it really comes down to this idea that we have sort
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of co-opted our employers to provide health care,
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right? And so for people who are on Medicaid,
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either their employer doesn't provide it and they're working full time just like
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the rest of us, right? Or they can't afford it because they're
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not getting paid enough to actually afford healthcare and so they're on Medicaid.
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Or worse, they they have an injury or ~
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~ a a disability that keeps them from working in a in a on a regular pace
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or at a regular clip or holding down a steady job and so they also need
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to be kept alive through healthcare,
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through basic needs that any other human being really has.
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Right. And if like you said, they're if they're already at work,
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I mean what is working for their benefits?
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How's that different and why does it you know,
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if they're they're already doing eighty hours a week,
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it's like, well, okay, now you deserve Medicaid somehow.
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~
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Right.
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What what I I kind of pulled in from this that I thought was interesting
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was the whole ~ not just eighty eighty hours,
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right? It can of work, it can also be ~ other programs or other systems.
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Qualifying activity. Yeah.
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~ I
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looked a little bit into that here in Oklahoma and there is ~ two
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or three ~ work Oklahoma projects programs that are ~ allow you to to to
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participate in a thing for at least 80 hours a month.
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Wha a couple of them are nonprofits.
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You could so you can also apparently go to like a church,
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right, and get them to sign a form that says that you did volunteer work
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for 80 hours a month. ~ there's also a
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an actual like state work program where it's sort of like day labor where
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you can you be kind of picked up.
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And you don't necessarily get paid for it.
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I mean, but you can get paid for it.
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If you're working directly for the state,
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you don't get paid for it. It's just like a a program.
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But you can be paid for it. And if you just have a standard job where you're working
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at least part time, I think that's where the eighty comes from,
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by the way. At least in the Oklahoma program,
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is that forty hours a week times on an average four weeks is a hundred
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and sixty hours and they build a year of labor around twenty eighty.
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So a half a year of labor, I guess they
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they consider to be at least part-time.
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Anything less than that is considered a hobby.
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That's where I think the 80 comes from.
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But I think for a lot of people,
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this is just gonna be just another hurdle that they have to jump through
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in order to receive something that I mean I personally think should just
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be single payer. Like I think we should have healthcare and our taxes should
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be used to fund it and it be not for profit within the United States.
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But this is just another hurdle
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that now people who literally either can't work,
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don't work, and they have to figure out h what they can do for eighty hours a month,
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or they're they're not making enough money to afford health care.
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And we're telling them we have to they have to do more than than they're already
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currently doing in order to to receive health care that's provided
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by our ability to care for one another.
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Well it should be an exciting episode.
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Let's let's go ahead and turn to the meat of it and maybe we start with
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the joke or the the saying turned upside down because it tells us exactly what
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the phrase was built to describe.
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Alright, in eighteen thirty-four,
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so almost two hundred years ago,
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~ the workman working man's advocate,
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~ of course, you know, that's a dated name right there,
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right? The working man's advocate mocked the Mr.
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Murphy, who could supposedly hand himself over a barnyard fence by his bootstraps.
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Popick and Zimmer call it the earliest known use.
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So this is you know, sort of back in the history of our country and or you know,
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some somewhere way back in those days.
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And we have the idea that somebody can pull himself over a fence by his bootstraps.
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Now obviously on its face that's absurd,
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right? ~ it's satirical material,
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right? it's a it's an impossible thing to do.
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But somehow
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And it was seen as such.
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that became yeah. But but it's not anymore.
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Why is that?
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Yeah, I I I mean I I have to be honest,
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I think it it kind of comes from this like conservative movement.
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It didn't it wasn't until the nineteen twenties,
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right? So we're looking at beginning of of ~ or end of World War One,
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right? The beginning ~ the end of the the great times,
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~ at the end of the twenties where it actually swapped itself around,
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right? ~ I think that that that likely was part of a cultural revolution
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at the beginning.
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It was I mean the whole thing was was a punchline.
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It was just like, you know, when you see an editorial in the New York Times,
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one of the editorial cartoons.
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It was very tongue in cheek. It was very heavy handed because you can't
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you you can't fly by flapping your arms fast enough.
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It should be put on a mug somewhere.
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So it's just kind of a case of like
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it's kind of a case of like canky doodle dandy like adopting it and
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to empower the the term on your own like people are basically saying,
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you know, Hey, the government's asking us to pull ourselves up by our bootstraps.
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That's ridiculous. And the government's like,
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Yeah, yeah, you should pull yourself up by your bootstraps.
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Just own it.
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Yeah, I think
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they ran out of money. Like they were just like,
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Well, we well we don't know what to do,
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so figure it out. Do it yourself.
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Wow. Well
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Right.
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I guess that's one way to do it.
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I think you know, there was a a North American review ~ in eighteen sixty seven,
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so about thirty something years after that original one,
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~ that compared a man or it was a foolish effort compared
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to a man lifting himself up by his bootstraps,
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right? ~ same drawer as as kind of wheeling yourself in on a wheelbarrow,
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or getting rich by moving money from one pocket to the other.
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You know, I watched that ~ that three stooges bit the other day where he's like,
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you know, you owe me twenty dollars and he's like,
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No, you know, you or he's like,
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I twenty dollars. He's like, No,
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you don't, you owe me ten and then they end up handing the money around
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and everybody gets paid and they've all
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Right.
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paid each other back and the same dot it's the same twenty bucks that's been passed
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Exactly.
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around.
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I think I think that that's kind of all part of it,
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right? Like moving money between your pockets and calling that progress.
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Let's keep that in mind as we as we move toward the the whole Georgia situation.
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Right? And then the nineteen twenty two,
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right? Joyce Ulysses uses bootstraps for someone who forced their way
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up from the lowest rung.
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That is ~ it's the OED's earliest example of a phrase the phrase actually meanings
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an achievable goal. And so the idea
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course that's in
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Ulysses, which is a surrealist like novel,
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right? I it's not it's not actually meant to make a lot of sense.
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Right.
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So it's kinda funny that they choose that as the the source material.
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Well, I I think it's probably looking back at it more so than necessarily,
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you know, it written with that purpose in
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Well sure, yeah. But I mean it somebody latched onto that,
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right?
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mind. Right, exactly. But I I think that that at one time,
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right, we did have a ladder. And so it made sense to like well,
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I mean really it's just lifting your your leg up,
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right? And so w if you lift your leg up you can get on that next run.
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The problem is there's no rungs.
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Right. So what am I supposed to do but lift myself up to a rung that
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I can't reach reasonably?
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I'm I'm lifting my arms up here in case you can't see me on this podcast.
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Individual descriptor. ~
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Right.
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yeah, so I I I get what you're saying.
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So you're just it's like somehow the context got lost and the idea is that
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it sounds like something honorable to like lift yourself up by your bootstraps,
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not literally to like pull yourself up into the sky with no nothing to stand on,
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but to climb the ladder of success.
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Yeah, it's it's to kind of make your own way.
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Right. Well, ~ so clearly somebody forgot something in between
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the joke originally being stated as like a nonsensical thing that nobody could do,
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an impossible task, and then becoming the way that we're you know meant to live,
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the the upright, honorable way to live.
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Right. So not long after that,
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right, nineteen twenty eight, ~ Hoover was at Mad Madison Square Garden,
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and he was talking about this this concept of this rugged individualism against
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European paternalism and state socialism.
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The Depression era obviously arrived a year later,
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~ to sort of grade what Hoover was talking about at Madison Square Gardens.
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But
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It introduced this idea so it goes from from right the eighteen thirties as
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a as a joke to you know eighteen sixty seven and it's used again
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and specifically as your bootstraps as opposed to your laces or the leather
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of your shoes, right? And it's used then again in the twenties
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in Ulysses to sort of morph into we're doing this ourselves.
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You have to do it you have to do your own y make yourself better on your own.
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As though
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You could pour from one cup to another.
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~ when you don't have the resources yourself to do it,
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you can't make more water by pouring it into two cups,
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right? It doesn't make two for two full cups,
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it makes two half cups. ~ because the amount
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Right.
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never actually changes. So then
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Only one of them's half full. The other one's half empty,
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so
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Right, so then it becomes this new idea that we have to we have to
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do our own thing. We gotta do it ourselves.
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Because ain't nobody gonna do it for us and it's and if you if you do,
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if we do it for each other, that's socialism.
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And so in the in twenty eight,
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that was sort of this idea that we have to abandon the concept of socialism
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and we have to do our own thing,
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this rugged we're rugged, we're tough,
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we can do everything by ourselves.
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Then the Great Depression hits,
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right? Like so and and people
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Oops.
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right, exactly. It's basically the first time we have rejected
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the concept of democratic socialism.
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He doesn't say democratic socialism,
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but he he calls it paternalism and state socialism.
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And literally as soon as we abandon that we we come into the Great Depression,
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as though we somehow need to lift ourselves up by our own bootstraps.
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~ then
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Or as if
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Hoover spoke a little bit too soon.
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Right. Then of course, fast forward a little bit further,
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by about fifty years, right? January of nineteen seventy-six,
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Reagan ~ comes into the into the scene describing a Chicago woman with
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eighty names and thirty adj addresses,
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collecting a hundred and fifty thousand dollars a year tax free.
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And so that's his that's he he came up with the welfare queen idea,
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right? He created this this whole
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So we go from not really being a possible thing to being
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a a more it's all about what you can do for yourself.
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You have to self improve, regardless of whether or not you have
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the abilities financially, mentally,
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morally, ethically, whatever, into this welfare queen
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who now has managed through state socialism to get free money
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by claiming different names and different addresses and
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not doing any work for it. ~ the person that was actually affected
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by this was ~ was Linda Taylor.
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That's he who's describing a specific person,
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which I think is interesting. ~ now the the Chicago Tribune was the
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one that called her the welfare queen,
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not Reagan. He just brought it to the national stage as like a this is a thing.
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So Josh Levin ~ of the ~ actually said she was real.
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So this was based on a real person.
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For one thing, she sounds fairly industrious to come up with eighty names
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and thirty addresses and cash all the right checks and get all that sorted
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out every month. But
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Right.
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but seriously though, I mean, you know,
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this is there's a a saying in in the legal world that's ~ bad facts make
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for bad law. Meaning like don't build your laws off of the most extreme cases.
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Well, this is exactly one real person with an extreme super extreme case,
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right? Who became the image that everybody carries around of anybody that's
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on public aid. Like this is what's frozen in your head now,
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right? When you hear like
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the the person living in the, you know,
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the poorer part of town or whatever grew up in a bad bad side of
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the street or whatever, bad side of the railroad tracks.
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But they're, you know, they're they're doing something they shouldn't be.
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Maybe they're enjoying a soda or something like that.
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That they just, you know, they're in indulging themselves.
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Well that's just the welfare queen over there living high on the hog with my money,
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my tax money that I paid.
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Right.
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And that's of course when it's based on that extreme vision,
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obviously you're gonna skew towards things that are not really ~ realistic
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for most people.
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For sure.
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So, ~ the the next idea we're gonna introduce you our audience to here
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is the drained pool. which is the idea of,
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you know, ~ sort of the I guess a broader expression would be cutting
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off your nose to spite your face,
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but rather than integrate the public pools in Montgomery,
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Alabama, they actually just drained the pool so that nobody could use it.
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Like if you know, if the whites couldn't have it to themselves then nobody
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was gonna get to use it. And ~ I believe it's a sociologist or
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a a political theorist,
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Named Heather McGee ~ refers to this as drained pool politics,
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which is zero sum racial politics.
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Which is zero sum. Exactly. As though
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Yeah, exactly.
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as though there's not enough for everybody,
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so nobody gets any so instead of everyone having a little.
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Right, which is not at all what happens with the pool situation.
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Like the the image there would be the if everybody went to the pool
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and scooped out a cup of water or something and took it,
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you know, for themselves to to splash around in.
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But that's not what happened. This city the city drained the pool
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so that nobody could have access to it.
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Rather than have access to less quote unquote less water.
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And of course in a pool you don't use up the water.
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So it's just the the whole thing is is nonsense like the saying in the first place.
18:07
Right.
18:07
But ~ once one outlier stands for everybody who needs help,
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closing the pool starts to look like the fair thing to do,
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right? If everybody if everybody on public benefits is a welfare queen,
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then the fair thing to do is take it away from all of ~ right?
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Which brings in the law.
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Right. ~ so we have ~ replacement of laws,
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the the original law dealing with federal benefits was ~ replaced
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in nineteen ninety six by the current law,
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which is a block grant with work requirements and time limits.
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And ~ it turns out that that law
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was re reached a shrinking share of families who are in need.
18:44
C B P links it to more children in deep poverty.
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So we can build the pattern now from eighteen thirty four to nineteen ninety six,
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and we see an impossible standard,
18:54
right? Lifting yourself up by your own bootstraps,
18:56
becoming recast as the test of the individual.
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You know, the person who has character ~ will,
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you know, give back to the community,
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will work hard and somehow better their community while they're getting
19:07
the benefit of public ~ public funds.
19:09
So who benefits when failing this test looks like a character flaw?
19:14
Is the question.
19:16
Right. So essentially pull yourself up by your bootstraps now means
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to to do something that you are required to do.
19:26
It's a personal responsibility of your own to make a better life
19:30
for yourself using no publicly pooled resources.
19:35
Basically invented out of thin air and give yourself a better paycheck.
19:42
You can see it echoed now in a lot of sentiments who say,
19:45
Well, you know, you just need to get a job and do it for yourself.
19:48
It's like, Okay, but I looked around and I have a job and I'm working
19:52
two of them and none of them provide healthcare benefits and the salary
19:57
is not enough to cover both is not enough to cover health benefits for just me,
20:02
let alone my family. And so they say,
20:05
Okay, well, then you need to not buy lattes and you need to not have a family.
20:08
It's like right, but I already have one.
20:10
Like I because I was promised that if I lifted myself up by my bootstraps,
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I would have a better life, but I can't materialize a better paycheck.
20:19
In the real world.
20:21
Right. Well that's that's the the basic idea.
20:24
So now we're gonna see what that ha what happens when this test is turned into
20:27
a form for someone to fill out and complete.
20:29
~ the way this test is gonna work,
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we're gonna use the example of Adrian McGonagall,
20:34
age forty from Pea Ridge, Arkansas.
20:37
~ worked at the shipping department at Southwest Poultry,
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~ but had Adrian had no health insurance from his employer.
20:44
Judge Bosberg, ~ is gonna be the the sort of case the
20:50
author of the court case we're looking at,
20:51
opened his twenty nineteen opinion with the the account of Mr Adrian McGonagall.
20:57
~ looking at Arkansas, June twenty eighteen was the first state
21:03
to implement a requirement of twenty hours a week for adults ages thirty
21:06
to forty nine. ~ it makes me both sad and kind of encouraged that I'm
21:10
on the upper I'm approaching the upper limits of that.
21:12
But regardless, ~ so when they require when they implemented this requirement
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in twenty eighteen in Arkansas,
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about eighteen thousand of the roughly one hundred thousand people ~
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who were targeted with this law or but lost their coverage.
21:28
They no longer had
21:29
Right.
21:29
access to health care.
21:31
Yeah, and and Harvard researchers in the New England Journal ~ said that more than
21:35
than ninety-five percent of these people who were targeted were already working
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or should have been exempt from the working requirements for either
21:46
the fact that they had a an an actual job already,
21:50
or they did not have the ability to work.
21:53
Right? So there were no job gains that they could
21:58
Could find in Arkansas at the time.
22:01
They basically built a machine to catch people who weren't working,
22:05
then pointed that exact machine at people who were working and caught them anyway.
22:11
In a lot of the same ways that you know,
22:13
I see a lot of parallels with the ICE situation that's happening right here
22:16
in the United States right now.
22:17
They built this machine to point at immigrants and now they're just pointing
22:20
it at Americans because they've run out of immigrants?
22:24
I'm not sure.
22:25
Maybe they're it's too hard to catch They actually find people that
22:28
are breaking the law. But yeah,
22:29
so ~ I guess the the to kind of clarify a point here,
22:33
Mr. McGonagall was working enough to qualify for Medicaid.
22:37
It wasn't that fact, it was the fact that he didn't follow
22:39
the procedure perfectly to the letter that that led it that put him
22:43
in the situation he was in, right?
22:44
And they make
22:44
these procedures difficult on purpose.
22:46
Yeah. Exactly.
22:47
It's like you
22:48
didn't fill out one box on a farm or make one check or you know,
22:52
have the have the ability to go through it enough times with a legal degree
22:56
to understand the legalese of all of it.
22:58
Another another example is Charles Gresham.
23:01
Now, he didn't work. He had seizures,
23:05
basically, that made work hard to find.
23:08
And when he could get a job, he had trouble keeping it because he was seizing
23:13
on a regular basis. The state website
23:16
was the only place that you could report your hours worked in order to stay covered,
23:21
right? And so he had trouble with the website.
23:23
This was 2018. This was an an older gentleman he who also had a
23:28
an ongoing medical health problem that kept him from being able
23:32
to access a computer. Now he presumably would have to have a computer at his home,
23:38
have the availability to use maybe his phone to fill out this form.
23:42
Or he could, I guess, go to a public library and do it,
23:45
but in order to do so, he'd have to have transportation.
23:47
You know, he had to ~ walk, presumably,
23:51
while maybe suffering a seizure on the side of the road and getting hit by a car.
23:54
There's so many things here, right?
23:56
But he was the lead plaintiff in the Gresham versus Azar,
24:00
which is the Southern Law ~ Poverty Law Center's National Health Law Program,
24:05
Legal Aid of Arkansas. In February 2020.
24:09
The D C circuit actually affirmed that Health and Human Services Secretary Alex
24:13
Azar's approval was arbitrary.
24:16
And that led to what outcome?
24:21
So the federal version, which passed in twenty twenty five,
24:24
~ when when Donald Trump came back into office,
24:28
it passed by literally one vote in the House,
24:32
two hundred and fifteen to two hundred and fourteen by a tiebreaker margin
24:36
in the Senate, fifty-one to fifty.
24:38
Like literally by one margin in both houses or b or both ~ institutions.
24:44
And Trump signed it on the fourth of July,
24:46
right? So this expansion approves adults.
24:51
19 to 64 makes them prove that they have worked 80 hours in a month unless they're
24:57
exempt starting in 2027. The exemptions are not quite clear,
25:03
but also eligibility will be rechecked every six months.
25:08
so nearly two-thirds of adult Medicaid enrollees already work,
25:13
according to Kaiser Family Foundation's health news.
25:16
The brief doesn't really name a sponsor or
25:20
Or a committee or you know, member by member vote.
25:24
So Trump signed it. You know,
25:27
Kemp's program is sort of the model.
25:30
Azar approved it for Arkansas.
25:33
And the FGA defended the policy at the Supreme Court.
25:36
This is happening. It's going to happen all over the country.
25:38
Every state has to figure out a way to make this work because regardless
25:43
of what state you're in, they might call it a different thing.
25:45
In Oklahoma, I think they call it Sooner Care.
25:47
~ in Iowa they call it Buckeye Care.
25:50
That i it all has a different name,
25:52
but all of these are funded by federal sources.
25:54
So when the federal law is made,
25:56
all of the states will eventually have to comply with it.
25:59
Well, so we've basically taken a law that was already questionably working,
26:04
~ arguably not working in the first place and expanded it to go nationwide.
26:08
Yes. And Sarah Huckabee Sanders used it as an example for the nation
26:13
of what we should use because it worked in Arkansas,
26:16
when really their definition for it worked was that less people
26:21
Right.
26:21
are on it. It's like right, you're letting people die because they can't
26:26
get access to health care, even in a situation where they can't afford
26:31
it themselves because of the economy of the state of Arkansas,
26:33
and you're gonna make that a a national thing.
26:36
The
26:36
Right.
26:37
It works. It's kinda like in the words of Inigo Montoya.
26:39
You keep using that word. I don't think it means what you think it means.
26:42
Right. And all of this was to basically save three hundred and twenty
26:46
six billion dollars ~ from the
26:52
the the coffers of the federal government.
26:55
~ the Congressional Budget Office sort of breaks that down as nine hundred
26:59
and eleven billion in total Medicaid cuts,
27:02
~ with the work requirement being the largest single source at three hundred
27:06
and twenty six billion over ten years,
27:08
mostly just from people losing coverage.
27:12
Literally that's one of the goals.
27:13
essentially,
27:14
like to get the count to get the cuts to what they needed to be,
27:16
we need to assume that three hundred and
27:17
Regardless of the consequences.
27:18
twenty six billion dollars worth of coverage will be lost mostly.
27:21
regardless of the of the consequences.
27:23
And that means that eleven point eight million people are gonna lose their health
27:28
care coverage by twenty thirty four because of this federal law.
27:33
And then another five point one million of those eleven point eight
27:38
are basically related to policy outside of the bill from its from its own number,
27:42
right? So the savings mostly come from poor people
27:49
losing their health care coverage.
27:51
The budget only balances, in this case,
27:55
according to this law.
27:57
If people fail to meet the requirement and then have to drop off of Medicaid,
28:02
we are basing our budget balancing on whether or not well in this case
28:08
not people fail.
28:10
Yeah. This is literally an omelet that will require breaking many,
28:14
many eggs. ~ so to put it plainly another way,
28:19
the question of whether somebody's working enough as it is ex only exists because
28:23
coverage was made conditional on answering that,
28:25
right? Nobody worried about that until they made it conditional.
28:27
And the savings get scored on how many people don't actually answer
28:31
in time until they lose their coverage through a technicality.
28:34
Right. Which brings us to Georgia.
28:35
So let's
28:36
yeah, let's go back to Georgia.
28:38
Governor Kemp.
28:40
So
28:40
So
28:40
we have the pathways to coverage here,
28:42
right? ~ and that's that's gonna cost more than eighty six point
28:45
or estimated it cost more than eighty six point nine million by the
28:49
end of twenty twenty four, about three quarters of it to consultants.
28:53
Which is gonna be this is where the story gets even worse.
28:57
Right. So the government accountability office,
28:59
fifty four point two million of that eighty six point nine million
29:05
is just gonna be spent on administrative costs of administering the
29:10
the proof of work program. Okay?
29:14
So qualifies for working in Washington these days.
29:16
Right. And only twenty six point one million of that eighty nine
29:21
is actually on health care. Two dollars to check whether or not a person
29:28
is meeting a work requirement for every actual dollar of health care.
29:32
And the GOP lawmakers are still calling it the perfect model for our country.
29:38
A actually Senators Warnock, Osof,
29:41
and Wyden.
29:42
Ask the the government accountability office to investigate in December
29:46
of twenty twenty four this exact program for that very reason.
29:51
~ I mean, the world's upside down,
29:54
right? When when the world turns upside down it's hard to tell.
29:57
Everything's upside down, right?
29:58
~ so just imagine what it's like to be Mr.
30:03
McGonagall, agent McGonagall in this situation,
30:04
right? He's working at a meat packing plant.
30:07
~ I'm sure he works at least eight hours a day,
30:11
if probably not some more time,
30:12
and there's probably time on there that he's not compensated for getting
30:15
his gear on and getting it cleaned off and he comes home smelling like raw meat.
30:19
And you know, when's he supposed to go and fill this this paperwork out?
30:22
Well, you know.
30:23
Obviously he's not gonna do it during working hours because that's when
30:26
of course that's when all the offices are open,
30:28
right? So they don't open on the weekends.
30:30
So when's he supposed to go? Well well he can just do it online if that's a problem,
30:33
right? Well those these government websites,
30:35
as we talked about before, are difficult,
30:37
notoriously difficult to navigate,
30:38
even for lawyers. Like I'm trained to read legal documents
30:42
and understand how things, you know,
30:43
understand the workflow and these kinds of things.
30:45
And it's hard for me sometimes when I open these ~ these pages to figure
30:48
out what's going on. So, ~ I mean this is where the the
30:53
working man or working person ~ kind of falls off the map,
30:57
right? Or falls off the the ledger because they're clearing the way for
31:02
~ this model outcome that means that nobody gets healthy care coverage.
31:06
But before we get too
31:07
I think
31:08
comfortable on our side of this,
31:09
go ahead. Sorry Joshua.
31:10
I was gonna say,
31:10
you know, ~ in addition to this,
31:12
right, we're assuming that this guy's gonna work a normal nine to six schedule,
31:15
right? the library is gonna be closed outside of that.
31:18
So in order to be able to access this website,
31:21
you have to have access to either a smartphone with with an ~ cell phone service
31:25
package, or your own computer that you're maintaining or a tablet
31:29
or something like that with internet service.
31:31
Right? So if he's working nine to six and a bank's only open nine to four
31:36
and the library's only open eight to five.
31:40
He doesn't really have the opportunity other than maintaining an expense that
31:44
he doesn't necessarily want or need to create a mandate to fill out paperwork
31:50
in a form that he's working these hours that he's already clearly working.
31:54
And we can see that because he's paying taxes on his income to the IRS,
31:59
so we know how much he's actually working,
32:02
and how much per hour it's all sent to the IRS.
32:05
But now he's gonna have to go to through a separate hoop to submit
32:09
all this information and possibly incur the expense of a computer or a tablet
32:13
or a laptop or a cell phone and an internet package or a cell phone package
32:17
in order to be able to fill out these forms and somehow manage or somehow manage
32:21
to go to a library outside of those hours and fill it out there.
32:24
Well, it sounds like we've got this pretty well sorted out,
32:27
but before we get too comfortable,
32:29
let's take a look at the case for the other side and part of that
32:32
is a legitimate argument. So ~ let's this take take us back in time
32:37
now or forward in time, I figure where we left ourselves.
32:39
But we're gonna go to the San Francisco Fed in twenty nine.
32:44
And it was there were fears about that single mothers would sink deeper into poverty
32:49
after the nineteen ninety six law didn't pan out.
32:51
So caseloads fell.
32:54
Employment and household incomes rose.
32:56
~ you know, there was kind of chaos there.
32:59
And the Congressional Research Service reported,
33:02
~ report R forty five three seventeen,
33:05
welfare to work experiments that paired requirements with job
33:09
and education services raised employment and where wages,
33:11
right? So this is a study the Congressional Research Service
33:15
put together and figured out that this welfare to work experiment
33:18
was producing good results, right?
33:21
So that's encouraging from that perspective that if you can p p put people back
33:24
to work or get them to at least try to work some even while they're on welfare,
33:27
~ maybe they can they can make the transition,
33:30
right? They can literally pull themselves up by their own bootstraps.
33:33
~ the Foundation for Government Accountability says attracted more than
33:38
a million adults under the snap work rules,
33:40
and many went back to work with incomes more than doubling a in a year.
33:44
Now, doubling from welfare checks is
33:49
Not as impressive, but hey, it's it's head in the right direction.
33:51
And then there's reporting from Levin that that the Linda Taylor case,
33:56
right? We talked about the welfare queen already.
33:58
Linda Taylor was real. The furs and Cadillacs were real,
34:01
and her alleged crimes were well past welfare fraud.
34:03
So again, I mean this is again this is a real person,
34:06
right? So it's not a made up story.
34:08
But it is a very unusual, exceptional individual,
34:11
right? And this and clearly a criminal criminal mind.
34:15
I don't know if mastermind may be too strong a word.
34:17
But clearly a criminal mind here.
34:18
There was more than just welfare fraud involved in our enterprises.
34:21
And then we get Georgia saying that a two-year launch delay drove part
34:25
of the pathway's costs. So they're they're trying to justify why that
34:29
$80 million or $89 million, whatever it came out to,
34:32
~ saying that a two-year launch delay drove up those administrative costs.
34:36
And CMS calls the vendors $600 million pledge-free and discounted help.
34:43
So what what that means is the the people that they hired for these that they
34:46
allotted that money for just took it as a tax deduction,
34:49
right, instead of charging them directly.
34:50
So that money they still got their they still got covered for that in the form
34:55
of a the tax write off. ~ so where does that leave us,
35:01
Joshua? What do we what do we actually believe at this point?
35:03
Well, what what do you believe,
35:05
Will? I mean, ~ there there are they have legitimate some legitimate return right
35:09
here that they that what they were trying to achieve,
35:13
some of it happened. I I I guess the w and I want to present it that
35:18
way because some of the things that they were claiming absolutely did happen.
35:21
I don't think it accounts for the actual human cost in this,
35:26
though. Right? Like, ~ yes, we saved some money.
35:29
Yes, some people that they tracked under
35:32
These same guidelines for literally supplemental nutrition and food assistance went
35:38
back to work because of these work requirements and ended up doubling their income
35:45
because they went back to work.
35:46
Okay, that's valid, but you did it by literally taking away their ability to eat.
35:52
And so
35:54
Right. mean it's one thing
35:55
to say there's positive outcomes from these these kinds of programs.
35:58
It's another thing to use those outcomes or use the the one of the steps along
36:02
the way as a measurement for whether they qualify for the original care
36:06
in the first place. Right. It's like this is basically saying we
36:09
can change some things, we can we can help get them on the road
36:11
to recovery by putting them back in jobs and getting them ~ earning income.
36:15
But if we look if we flip that on the reverse side and say if we set this
36:18
as a minimum bar for getting the ~ the federal funds in the first place
36:24
That's a good way to clean a lot of people off the the ~ ledger,
36:28
right?
36:29
Yeah, I think I think if you if you read the if you read the C R S all the way down,
36:33
right, the the gains were usually ~ modest.
36:36
They were often faded, you know,
36:39
and they they didn't really raise incomes unless their earnings were supplemented.
36:44
So those programs that they created essentially came with services.
36:49
The Medicaid version of this comes with like
36:52
a logon and essentially a work requirement.
36:57
of administrative paperwork on top of an actual work requirement,
37:02
right? The FGA number comes from the FGA,
37:06
the same group that filed the Supreme Court brief defending the work requirements.
37:11
Other studies actually found s much smaller gains and smaller losses.
37:15
Of course they're not going to report those.
37:17
They don't stack up to what they were trying to achieve.
37:20
The CBPP credits more than more of the post
37:26
Nine ninety six gains to a strong economy and the earned income tax credit,
37:32
right? So and points to more kids in deep poverty.
37:36
All ten pledging vendors already hold state Medicaid eligibility contracts.
37:43
It's basically like
37:44
And this is
37:44
the the first bag is free kind of a sales strategy.
37:47
Right. ~ ironic, given that who was driving this.
37:51
But ~ yeah, I mean that's that's the classic case of never letting the facts
37:56
get in the way of a good story,
37:57
right?
37:58
So wh wh what have we settled and what's still that issue here,
38:02
~ at this point?
38:05
Well, so I think Arkansas Arkansas lost their coverage,
38:10
right? There was no actual measured job gain in that because there aren't it's
38:16
not like i if you increase work requirements that jobs are going
38:19
to increase in turn.
38:21
And then you have the Georgia case where they spent two to one on just
38:25
the actual cost of implementing the program that they could have been just using
38:29
toward the actual care.
38:31
And so I think, you know, whether or not the nineteen ninety-six
38:37
law actually caused the gains,
38:39
~ that's kind of the the San Francisco Fed versus CBPP,
38:44
right? And then you have this this corrupt company that's essentially tracking
38:49
all this information who directly benefits from these facts being true.
38:55
Now, what is real is that
38:59
Requirements with services attached have actually raised employment ~ modestly,
39:04
according to CRS, right? I mean,
39:06
so that's a real thing. So essentially when you say,
39:08
hey, look, we'll give you more ~ benefits to yourself and benefits
39:13
to grow your life, and that might be small things,
39:16
right? We we will help you with education to help you get into
39:18
a different workforce ~ you know,
39:21
that ha is more demanding or ~ has more demand in it,
39:25
or you know, we might
39:27
If you qualify for SNAP, you might also qualify for Medicaid,
39:32
right? Or if you're filling out your SNAP requirements,
39:36
which the state of Oklahoma again requires eighty hours a month for
39:40
you to have SNAP. But you still have to log it in two places under this
39:45
new Medicare law. Maybe they'll combine them,
39:47
right? Maybe maybe if you you know,
39:50
if they share the information,
39:51
if the IRS shares the information with the Congressional Budget Office,
39:54
th of
39:56
This person is working this much,
39:57
maybe we can eliminate the requirement altogether.
39:59
But I think that the entire situation is corrupt.
40:03
Right?
40:04
Yeah.
40:04
The the welfare queen story, that's real.
40:08
I'll get I'll give it I'll give them that.
40:09
That was a real person doing a really bad thing.
40:12
But that stuff's already against the law.
40:14
It's fraud. We should absolutely try people in a court with real
40:20
consequences.
40:22
For people who abuse these systems.
40:23
I I'm not saying that we shouldn't we shouldn't ~ avoid or that we should avoid,
40:29
you know, prosecuting or or keeping fraud out of these these systems.
40:34
It's like the getting rid of fraud and waste and all this other stuff.
40:37
Yes, we should do those things.
40:39
But we should not take actions that would directly cause someone harm in order
40:45
to do it. And that's that's almost every turn of these these
40:50
policies and these ideas that are overwhelmingly coming out of the
40:55
out of the conservative wing of our government are an attempt to cut budgets
41:00
at any cost. And I I think that they they failed to understand that there
41:05
is a cost to all of this, but it's a human one.
41:07
It's just easier to to I guess track on a spreadsheet when it's
41:14
a dollar number versus an actual impact on people's lives.
41:18
And I I've said this many times personally,
41:20
I think that I would rather,
41:24
you know, feed forty people that don't deserve
41:29
to eat to make sure that a hundred kids who actually need
41:34
the food to to actually be able to eat,
41:38
right? Like if if that takes me paying taxes to feed forty people
41:43
who don't actually meet the requirements,
41:45
I'm okay with that. Should we hunt?
41:48
Down those people who don't and every now and then audit our system
41:52
to make sure we're not doing those things.
41:54
Yeah. Right. But it's a lot better
41:59
for an administration's claims if they're trying to get re elected,
42:03
to say, hey, look at all of the all of these budget line items we were able
42:07
to to cut without pointing to the fact that we cut them by stealing literally food
42:12
out of children's mouths.
42:13
Well, one thing we can ~ sort of confirm or or validate absolutely,
42:17
you know, and the one thing that's sort of black and white is the
42:20
~ the actual invoices themselves,
42:23
right? So we talked about Georgia paying twice ~ two dollars for every dollar that
42:27
they recovered. we can actually look to the invoices and see how that came about.
42:31
So ~ Luke Seabourne
42:32
So let's look at them.
42:34
What's that?
42:35
I said l I said let's listen let's hear
42:37
Okay, sorry. Luke Seaborne appeared in Georgia's own twenty twenty four promotional
42:41
video for Pathways. Meanwhile,
42:44
red tape has caused him to lose his benefits twice.
42:46
And this goes goes back to a little company you may have heard of called Deloitte.
42:50
Are you familiar? Yeah.
42:51
never heard of Just kidding.
42:52
~ so one might wish. But they were paid ~ and Deloitte is generally considered
42:58
a consulting agency, but that doesn't really begin to cover what they do.
43:02
They do a lot more than just ~ consulting.
43:05
We'll get that in a second, but ~ Deloitte was paid more than fifty million dollars
43:10
for pathways eligibility software that reportedly often froze
43:13
and wiped out applicants' information.
43:15
So a fifty million dollar piece of software to do one thing and it it
43:20
it couldn't do that one thing.
43:21
The contracts
43:22
At least not well.
43:23
were obtained through at least not well exactly.
43:25
the contracts obtained through public records were heavily redacted,
43:29
but that's what we do know about the Deloitte deal so far.
43:32
So two point four million to write you know,
43:38
a shitty app. Over fifty million to build that system,
43:42
ten point seven million to advertise that now that system exists.
43:46
And during the ad contract, enrollment went from about two percent
43:50
of eligible people to under three.
43:54
So less than a full percentage point.
43:56
Right. Paid to write the test,
43:58
paid to build the test, paid to promote the test.
44:03
Somewhere in that whole mess,
44:06
a sick guy in a promotional video got kicked off of it twice.
44:12
And somebody made the decision to put that that specific guy in that situation.
44:18
Someone named Deloitte executive,
44:20
apparently.
44:21
Right, Maximus twenty twenty six this year.
44:24
CEO Bruce Caswell's company told investors in August that states implementing
44:30
HR one will bring back growth.
44:32
They called it attractive new work opportunities.
44:37
On its february twenty twenty
44:38
Consultants.
44:39
six call, it reported a fifty nine point one billion dollar sales babillion
44:46
dollar sales pipeline.
44:49
fifty nine
44:49
Wow.
44:50
percent of it was new work including Medicaid and Snap.
44:55
Optimum Health, you've heard of them.
44:56
If you if you have ever used United Healthcare,
45:00
right? The United Health Group,
45:02
a one hundred and twenty five point six million dollar Vermont eligibility contract
45:09
as of October of last year, covering the work requirement and six month rechecks
45:13
~ among other work. So yeah, it's creating jobs.
45:17
It's creating jobs by literally harming people.
45:20
To to administrate the systems to harm people.
45:20
I just like the fact that the when they needed to Yeah,
45:23
I l I just love the fact that when they looked they needed to know who
45:26
to kick off the the rolls, they turned to United Health Group.
45:28
As like, you know, not as insurance expert,
45:31
but as an expert on tracking people and making sure that you could find ways
45:34
to kick them off.
45:35
They have really good systems to kick people off.
45:36
Hey, they're using AI to do it.
45:37
Exactly.
45:39
You know, I mean Charles Gresham,
45:43
right, lost coverage over a website that literally couldn't work.
45:46
It wasn't that he did something wrong.
45:47
He did all of the things, he did the requirements.
45:49
It somewhere got lost. This and it could have been something simple.
45:54
The save button was not visible.
45:55
You had to scroll down, and maybe he's an older guy,
45:57
you know, like he didn't see the save button.
45:59
So he's like, I filled out all the forms.
46:01
I don't know what else to do.
46:03
And he exits the website and all that information never
46:04
He didn't consent the marketing.
46:05
makes it into the system because they had a bad user interface,
46:08
right?
46:09
Or he didn't consent to be marketed to the marketing opt in and they wouldn't
46:12
let him click through.
46:14
Right. He didn't read the Eula.
46:15
Adrian McGonagall, that guy had a full
46:17
Yeah.
46:17
time job. He was working in a meat packing plant and his employer didn't offer
46:21
insurance. That's literally the people who Medicaid was designed for.
46:26
And it's literally the people that they say they want on this system,
46:29
but they're adding additional burdens in order to stay on a system that's working
46:35
exactly like it was already designed to.
46:37
~ and this is this I mean, these are real people that we're talking about here.
46:40
And now that it's gone nationwide,
46:42
it's gonna be real people that you know,
46:43
most likely. If someone at your job has no employer coverage and
46:47
is on expansion Medicaid starting in twenty twenty seven,
46:49
they're gonna be proving their hours through a system that a contractor
46:53
is building right now.
46:54
So the question that we we're we're left with really is is like who sits
46:58
at the top of this situation, who sits at the bottom?
47:02
And once again, I think Will and I probably both agree on this,
47:06
it's the people who are already hurting that are at the bottom of this.
47:10
Like they're already
47:11
Agreed.
47:12
unwell, they're unhealthy, they're overworked,
47:14
or they're handicapped and unable to work,
47:16
incapable of of holding down a job,
47:18
not because necessarily their abilities,
47:20
but because their ~ their employer's view of their reliability.
47:26
Or it could just be something as simple as as someone getting pregnant.
47:32
And not having ~ not wanting to to have to pay for their health insurance premiums
47:38
and and those sorts of things to to exit them from the system so that they
47:43
can share the responsibility with the world while also voting in people
47:47
who are taking those things away as well.
47:49
The people at the top, they're the obvious people.
47:52
They're always the same people.
47:54
They're so giant software corporations,
47:56
huge, huge money-making ~ you know,
47:59
~ enterprises.
48:01
That to be fair, they're like,
48:04
well, we're just executing, we're helping.
48:06
We're we're private companies partnering with the state to help them create what
48:12
they what they have put into law.
48:14
But we're not really understanding the data that they're using,
48:18
and we're we're changing the outcomes of these situations based upon what
48:23
the data actually shows.
48:25
So
48:26
Did you bring home for a landing for us,
48:28
Joshua?
48:28
Yeah. If you say that the testing measures work.
48:33
Then nearly two thirds of adult enrollees
48:38
in Medicaid are already working.
48:41
In Arkansas, ninety-five percent of them were either working or completely exempt.
48:45
And they didn't really create any jobs through this.
48:48
So they had to go looking for jobs that weren't there and work them
48:54
in order to continue receiving their benefits.
48:56
So if if you think it saves money,
48:58
326 billion of 911 billion,
49:02
it's really mostly from people losing coverage.
49:06
Georgia spent fifty four point two million on administration and twenty
49:10
six point one million on actually helping people.
49:13
So if you think that work requirements can work,
49:16
there are only modest gains when we actually look at the information.
49:20
The San Francisco Fed found employment rose after nineteen ninety six.
49:25
The that was mostly the dot-com bubble,
49:27
but the the Medicaid version just attaches paperwork to it.
49:30
It's like, well, we just need to track it better.
49:32
It means we need another whole system.
49:34
If you think that vendors are just doing a job,
49:37
these companies are calling these things a growth driver,
49:41
which means they're just making gains for the stock market overall.
49:46
And ten of these pledging vendors already hold contracts.
49:50
If the the well fair queen was invented,
49:53
we know she was real, according to this Leven guy.
49:56
But we're punishing everyone for one person.
50:00
So Georgia's Deloitte contracts came out through public records,
50:05
right? Heavily redacted public records,
50:07
but you say there isn't one.
50:10
public record. You can look it up.
50:11
You can go look out online.
50:13
So I mean it sounds like we're talking at best nominal gains that are gonna
50:19
be a drop in the bucket compared to the number of people that
50:21
are eliminated from the system altogether.
50:23
And that's where the real money's made,
50:24
is the government recouping the the expected forecast costs
50:28
for those individuals who do qualify at this time.
50:31
Is that fair to say?
50:32
Yeah.
50:33
I not just that, I also think I I I I hate to make future predictions because
50:37
they're they're, you know, fifty fifty wrong.
50:40
I think that this is gonna be used in the future because when you when these people
50:44
drop, they're it's not like their health needs are gonna go away.
50:47
They're just gonna stop treating them.
50:48
So if we ever do move toward a better system where we maybe stop prioritizing profit
50:55
over people's literal lives or something to that effect,
50:58
I think you're gonna see conservatives say
51:01
C, we did this and look at how many people are abusing this.
51:05
It's like, no, you took it away back then,
51:07
and then when we fixed it, we we're dealing with the healthcare issues that fell
51:12
out because they fell off.
51:14
Like that's that's the con, that's the whole thing,
51:17
start to finish.
51:18
So we went from a joke in eighteen thirty four to a an ~ admonishment
51:23
in twenty twenty or in nineteen thirty,
51:25
nineteen twenties, it was an admonishment and now in twenty twenty seventeen it's
51:29
a login screen.
51:30
That's pretty much it. We're we're all gonna be required to prove everything
51:34
all the time, despite the fact that we already have systems in place that currently
51:38
will tell you whether or not someone is.
51:41
If you even if you believe that it should be the case and that we should have
51:45
the all these requirements, why are we passing it on to the person except
51:50
for it's just another barrier to put in front of somebody so that they can't
51:54
get the things that they actually need?
51:56
That's it. That's the whole point of the podcast.
52:00
No, I'm sorry to leave you with this this time.
52:02
No,
52:02
there's no it's just th this is we're just we're just explaining a thing that is.
52:05
And it it's it's not just healthcare,
52:09
it's a it's a greater it's a greater theme that we're seeing throughout.
52:13
Joshua, where can they find us if they want to engage in the discussion further?
52:16
Yeah, you can find us on our website,
52:18
we're at FOF.foundation. You can ~ rate us on your favorite podcast app of choice,
52:24
whatever you're listening to this on right now,
52:25
just give us a rating, five stars please.
52:27
If you want to send us an email,
52:29
you can email us at the overlap at fof dot foundation.
52:33
Other than that, I don't know.
52:35
Be kind to each other. Help out where you can.
52:38
See you next week.
52:39
With that, we'll say bye.
52:41
Bye.