• In 1996, 22 percent of immigrant-headed households used at least one major welfare program, compared to 15 percent of native households. After declining in the late 1990s, welfare use returned to 1996 levels by 2001, with 23 percent of immigrant households using welfare compared to 15 percent of native households. (Figure 1)Table 1 shows the percentage of immigrants, broken into "all immigrants" and "legal immigrants" who receive some form of welfare: TANF; food stamps; or Medicaid. The rates of assistance for legal immigrants are higher than for natives. This doesn't surprise me a lot; many immigrants to America are refugees, often with little or no English skills, limited education, and sometimes pretty serious traumatic experiences before they arrived. But what is surprising is that there is very little difference in assistance rates between "all immigrants" and "legal immigrants." The illegals apparently use governmental assistance just a bit more than the legal immigrants.
• The persistently high rate of welfare use by immigrant households is almost entirely explained by their heavy reliance on Medicaid, use of which has actually risen modestly. In contrast, their use of TANF has fallen significantly, from a little under 6 percent in 1996 to slightly over 2 percent in 2001. Food stamp use has also declined significantly, from about 10 percent to 6 percent. These rates are now only modestly above those of natives. (Table 1)
• The decline in immigrant TANF and food stamp use has not resulted in a significant savings for taxpayers because it has been almost entirely offset by increases in the costs of providing Medicaid to immigrant households.
A regular reader points out something that tends not to get much discussed: a lot of elderly patients end up on Medicaid in end of life conditions, such as dementia. The reason is that it in many parts of the country, nursing care will run $5800 a month, and in some areas, $9000 a month. It doesn't take more than a few months for the average retiree to be broke enough that Medicaid comes into play.
He also points out that examining the bills for such nursing care leads to some pretty indefensible charges--like $360 for a three minute visit by a neurologist in a hospital who did nothing and $18 for a Tylenol tablet. Yeah, yeah, I know that there's some overhead involved, and some paperwork because a nurse has to go give the pill to a patient. But it does seem as though the $900 hammer crowd that used to work for the Pentagon is at work in the medical care system as well.
Perhaps instead of just increasing taxes to make a health insurance system for the uninsured, the left might want to consider if there's something that can be done to get the spending orgy under control first--and with the savings, use that to fund health insurance for the uninsured.
It is certainly the case that part of what is driving up the costs of our medical system is that it works a bit too well. There are an enormous number of people alive today who, in previous generations would never have made it to 50. I mentioned Dr. Andrew Weil's book Healthy Aging a while back. Weil made the point that more important than a long lifespan is a longer active healthy period of life. It does no good to add five years to a person's life, if those five years are spent hooked up to machines in a hospital bed. That's more like existence than life, and is it expensive, both to the individual, and to the society.
I think that most people share my view that it is better to live to 75, and go from active and healthy to dead in a couple of days, rather than living to 90, and spending the last five years of that life in severe discomfort, unable to do much but wait for nurses to change your diapers and give you sponge baths. (And that's one of the less unpleasant things that can happen to you at end of life.) That's why I think that medical research and medical care should be focused as much as possible on preventing health problems, rather than treating them once they develop.
UPDATE: A reader with experience working in military procurement points out that the $300 or $436 or $3000 hammer (depending on which of these accounts is correct) is an artifact of accounting practices no longer in use:
The contractor simply allocated his overhead equally among all items on the contract, from engines to hammers, which was approved by the government (a practice since abandoned). Had the contractor allocated overhead to each item in accordance with its "actual" cost, the overall contract price would not have changed (or maybe it would have gone up to account for the time spent calculating each line items actual overhead).
What the hammer story does show is that congressmen - and other people - with an agenda will eschew knowledge and disregard facts that get in the way of a pet project. I worked in military procurement for several years, and it became obvious to me that all the talk about efficiency and value was window dressing -- the real obstacles to efficient procurement are embedded in law, and the law is to make sure the government spends the money the way congressmen want it to, NOT to get the best price for a needed item. Small business and minority set-asides, buyAmerica acts, mandating that software contractors certify they are not using Ozone Depleting Substances (how many ODS's did you use last time you did some programming).
Heck, one of the biggest obstacles is that the government will not promise a contractor to buy more than one year's worth of items, because congress will not appropriate more than one year of money at a time, although there's no reason they can't. That would give up far too much control, too many opportunities to guide money into pet projects via earmarks and less obvious pressures. You will occasionally see Multi-Year contracts touted, but they few and far between.
Ever since the Defense Department procurement scandals of the 1980s, the $600 hammer has been held up as an icon of Pentagon incompetence. Immortalized in the "Hammer Awards" that Vice President Al Gore's program to reinvent government gives out to waste-cutters, this absurdly overpriced piece of hardware has come to symbolize all that's wrong with the government's financial management.
One problem: "There never was a $600 hammer," said Steven Kelman, public policy professor at Harvard University's John F. Kennedy School of Government and a former administrator of the Office of Federal Procurement Policy. It was, he said, "an accounting artifact."
The military bought the hammer, Kelman explained, bundled into one bulk purchase of many different spare parts. But when the contractors allocated their engineering expenses among the individual spare parts on the list - a bookkeeping exercise that had no effect on the price the Pentagon paid overall - they simply treated every item the same. So the hammer, originally $15, picked up the same amount of research and development overhead - $420 - as each of the highly technical components, recalled retired procurement official LeRoy Haugh. (Later news stories inflated the $435 figure to $600.)
"The hammer got as much overhead as an engine," Kelman continued, despite the fact that the hammer cost much less than $420 to develop, and the engine cost much more - "but nobody ever said, 'What a great deal the government got on the engine!' "
Thus retold, the legend of the $600 hammer becomes a different kind of cautionary tale. It is no longer about simple, obvious waste. The new moral is that numbers, taken as self-explanatory truths by the public and the press, can in fact be the woefully distorted products of a broken accounting system.
The root of the problem is as old as the Republic: Federal accounting has always been primarily concerned with making sure money was spent as Congress directed - not with making sure it was spent wisely. Historically, explained the Pentagon's deputy chief financial officer, Nelson Toye, DoD's bookkeeping systems were designed to "be able to satisfy the Congress that we were good stewards of the funds entrusted to us: We didn't overspend, we did spend it on what you asked us to, we didn't spend money to buy things you told us we couldn't buy." In the past, Toye said, "there has not been a requirement for DoD or any federal agency to routinely collect the costs of its assets and report those costs."