Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, February 4, 1993 TAG: 9302040386
SECTION: EDITORIAL PAGE: A9 EDITION: METRO
SOURCE: RAY L. GARLAND
DATELINE: LENGTH: Long
THE INS, OUTS OF WELFARE REFORM
PRESIDENT Clinton told the nation's governors that his administration will give the states new flexibility to bend federal rules governing Medicaid and welfare. As Gov. Douglas Wilder said, "He has been a governor for long enough to know where the shoe pinches."Let's hope our governor is right, and those good intentions aren't frustrated by the dedicated liberals likely to occupy key sub-Cabinet posts.
Wilder recently proposed a pilot program to use the cash equivalent of federal welfare payments to create a job-assistance trust that would support welfare families during job training and offer tax credits to businesses that hire them.
When it comes to poverty and welfare, there's something in us - perhaps the old Puritan ethic - that leads toward complex ideas of uplift. We've had various job-training schemes in the past; the results have been decidedly mixed. And tax credits for business are generally a good way to favor some at the expense of others.
The problem now is that a woman with three children fully integrated into the system can expect cash or cash equivalents worth about $14,000 a year. There are few full-time jobs available to them offering as much, and taking a part-time job generally translates into losing more in benefits than is gained in wages.
It would be nice to see a simple, broad-based approach to welfare reform that allows a person to take legal employment with only a partial loss of benefits. In fact, Congress could build on the earned-income credit already in place under Internal Revenue Service supervision to eliminate most welfare rigmarole. You would need to strengthen sanctions against those, like Zoe Baird, paying or receiving under the table.
Perhaps the greatest disincentive for the poor to seek employment is the loss of medical benefits. Simply allowing those now eligible for Medicaid to be kept on the rolls while working for wages would probably do more than anything else to encourage them to take jobs - and for employers to hire them.
Medicaid itself could be restructured as the foundation for a national system of basic care under which certain qualified businesses and The Associated Press reports that as governor of Arkansas, Clinton sought and received a waiver from the feds allowing his state to require Medicaid patients to choose a single source for primary care and to remain with it. While no one in his right mind would describe Medicaid recipients as medically privileged, the fact is that they are probably the largest group of Americans free to consume virtually all the medical care they can get - at almost no cost to themselves.
As a student in London in the '50s, I saw how the British operated socialized medicine and understood why they have generally good care at roughly half our cost. Your care was free, but in the great urban centers you had to visit the clinic to which you had been assigned to get it. The staff was on salary and had no incentive to offer more care than required.
The British were notorious for their patience waiting in line and dedication to law, so this might not work over here. But it ought to be tried, with private contractors operating one-stop Medicaid centers, convenient to public transportation in densely populated areas.
It would probably have to be on a fee-for-service basis here, but it would be nice to see how it would work if the government and private contractor could agree on a single annual fee for each Medicaid patient on the rolls - whether he or she used the system frequently or not at all.
Theoretically, at least, a health-maintenance organization accepting Medicaid patients for a set fee would have every incentive to avoid unnecessary procedures, practice economies of scale and keep people healthy. In sum, preventive medicine. Referrals to specialists and hospitals would be made by the primary-care provider, but not at his cost.
Good News: The Virginia Trial Lawyers Association has decided against finding a sponsor at this session of the General Assembly for a bill aimed at broadening the liability of business owners for criminal acts occurring on their property. In 1987, the Virginia Supreme Court ruled that a business owner is liable only if he knows that criminal acts are occurring on his property, or are about to occur.
While property owners must surely accept some responsibility for securing their premises, the protection of life and property is a basic responsibility of government. The standard laid down by the state's highest court is reasonable and should not be watered down by those whose mouths are watering for larger verdicts.
Same Old Thing: In the four years since Gary Collins was shot in Norfolk, the case against his alleged assailant has been delayed 12 times. Six of those delays were caused by the defense attorney, Del. William Robinson, D-Norfolk, who said he couldn't be present in court by reason of legislative duties. Two other delays occurred when Robinson forget to tell his client to come to court.
This type of behavior has been part of Robinson's pattern, and voters in his district seem indifferent. But the General Assembly could act to limit the right of lawyer-legislators to impose delays upon the courts only to those days when the legislature is actually in session.