Paper Hats

 The New York Times reported yesterday on how hospitals and medical systems across the country are scrambling to prepare people for the wave of new "work requirements" that go into effect in January, as part of Trump's big not-so-beautiful budget reconciliation bill. 

By all accounts, millions of working-class people are likely to lose health insurance. Many of them will actually meet the work, school or volunteering requirements under the bill—but they will lose status regardless, simply because of the complexity of navigating the new rules. 

As the Times explains, this is precisely what has happened in some of the early adopter states that have already implemented versions of the work requirements.  

One of these states reportedly protested to the Times that they "prepared carefully before launching work requirements [...] including training eligibility staff; communicating with community partners; and sending more than 75,000 notices, 38,000 text messages and 10,000 emails." 

Well, bravo to them. To quote Robert Tressell's The Ragged Trousered Philanthropists: "if the object of the committee had been to furnish the applicant with material for the manufacture of an appropriate headdress for himself, no one could reasonably have found fault with them[.]"

But if the purpose of this mountain of forms and notices was to enable people, not to make paper hats, but to qualify for health insurance, it seems that the state's apologia on this score rather vindicates the critics' point. The new rules have created a nightmarish tangle of bureaucracy.  

As the Times puts it: "many [low-income people] will fall off by missing filing deadlines and failing to navigate red tape, even if they meet the rules’ criteria."

In one of these states, according to the Times, "90 percent of the state’s Medicaid denials were attributed to incomplete or improperly filed paperwork," rather than to people actually failing to meet the new requirements. 

Our new Pecksniffian work requirements, then, seem like they will end up being about as fair and well-administered as the Edwardian "distress committee" Tressell satirizes in his novel, or the Benthamite "poorhouse Bastiles" Thomas Carlyle denounced in the Victorian age. 

Why are we doing this to people, again? Republicans often forget to explain that part. I'm not sure Trump could furnish a theory if asked. He'd probably mumble something about "fraud." Maybe some old-fashioned Republicans could eke out a phrase about the "dignity of work." 

We are told, for instance, that people who are offered free health insurance will have less incentive to work and will therefore fall into a "cycle of dependence"—thus, it's actually for their own good that they are being stripped of access to health care. 

But hang on a minute. Just because people can survive thanks to a public benefit doesn't mean they lose all incentive to work. They will still have the ordinary financial motive to supplement their income. 

So what people are really saying is that there are some jobs in our economy so profoundly awful that no one will take them merely for the extra cash and the higher standard of living they furnish—jobs so detestable no one will perform them unless the alternative is outright starvation or perishing of some preventable disease. 

And this coercion by threat of starvation or sickness is what we mean by the phrase "the dignity of work." 

Here again, Tressell has an apt word to contribute: 

Extraordinary as it may appear, none of them took any pride in their work: they did not “love” it. They had no conception of that lofty ideal of “work for work’s sake”, which is so popular with the people who do nothing. [...] How extraordinary this must appear to those idealists who believe in “work for work’s sake”, but who themselves do nothing but devour or use and enjoy or waste the things that are produced by the labour of those others who are not themselves permitted to enjoy a fair share of the good things they help to create?