Q: If a problem has gotten worse while spending money on it, is the solution to spend less money on it?
A: Yes, according to an editorial in National Review.
The author is Sam Adolphsen, “a senior fellow at the Foundation for Government Accountability,” a conservative advocacy group that has long been opposed to ACA in general and its Medicaid expansion in particular – what it calls “welfare for able-bodied adults” – not because it doesn’t work, but because it is too costly and unsustainable.
(The phrase “able-bodied adults” appears three times in the 700 word editorial. That really seems to get in his craw, the idea that anyone who isn’t old or crippled or a child should get Medicaid.)
What the editorial is specifically attacking is the idea that Medicaid to cover substance use disorder – treatment for drug addiction, alcoholism – is effective. Adolphsen concludes that Medicaid funding may actually cause substance use disorder.
His argument is like this: State had drug addicts/overdose deaths. State expands Medicaid to cover overdose prevention. Overdose deaths increase. Conclusion: Overdose deaths increase because of increased Medicaid spending.
“Another syllogism. All cats die. Socrates is dead. Therefore Socrates is a cat.”
– Eugene Ionesco, Rhinoceros
Notice Adolphsen says “may,” which means he concedes that you can’t prove such a syllogism without more evidence. But in every other aspect, he assumes there is a proven connection because that would mean his preferred solution would be the correct one.
He compounds this perception with the provocative statement, “Two questions must now be asked: Did expansion actually make the problem worse? And was Medicaid partly responsible for initiating the problem to begin with?”
Adolphsen never directly answers these questions. Let me: Not proven at best; deliberately deceptive at worst.
The vast majority of the overdose deaths in the study Adolphsen cites (which you discover if you follow his link; he doesn’t mention it) are from methadone, a drug almost exclusively used to get people who are already addicted to opioids to transition off of them. Getting an addict to quit is difficult, and relapses, sometimes fatal, are common.
Also, the 2009 study covers the years 2004–2007, before the adoption of the ACA. So the population we are dealing with would seem to already be addicts when they overdosed, not created by Medicaid expansion.
Many drug addiction treatment programs now prefer other treatments, such as Suboxone (a cocktail of buprenorphine and naloxone that reduces the possibility of abuse), Vivitrol (a once-a-month injection) and newer multi-month implants (Probuphine).
Just throwing money at a problem doesn’t solve it. But the solution is to see what else we can do, or what we can do better, not cutting off funding.
