Wednesday, May 14, 2025

Part I

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The Leviathan of Medicaid: The Problem of Medicaid and the Attempt By Republicans to Reform the Program

So many interesting things with worldview dimensions swirling around us, and perhaps today we can take a look at some of these. I’m going to start with the fact that the United States and China have indicated at least the beginning of a joint process to lower tariffs and to ease tensions on both sides, and so just about everybody saw this coming. The White House has made statements saying that it is doing this because of its determination to try to reach a proper accord with China, and it insists that the US is not backing down. However, at least to some extent, that’s exactly what the US is doing. On the other hand, this is not a one-way situation. By definition it’s a bilateral relationship. So China’s got to back down a bit as well. I don’t think anyone knows exactly what’s going to come out of this, but the point is we are living in a world that’s being transformed before our eyes.

The world order and every particular moment in the modern world has some understanding of world order. The current world order is being threatened by all kinds of disequilibrium, and so it’s interesting to note that if you look at the end of the 20th century, people, particularly in the West, were fairly certain that we had entered a period of unprecedented prosperity and peace. The fall of the Soviet Union, the fall of the Berlin Wall, other major events seemed to indicate what one famous historian, Francis Fukuyama, said was the end of history. History had simply ended with this: A new permanent or seemingly permanent stability. Well, it didn’t last. It didn’t last long at all.

Now, on the trade and tariff issue, there is no doubt that what was known as the basic economic theory of neoliberalism had really won the day, particularly in the West, but also in much of the developing world and especially in the fastest part of the developing world, and so you go to places like the Pacific Rim, quite honestly, there was an understanding that emerging nations faced an unprecedented opportunity, and you also had Western consumers who pretty much liked the picture moving in their direction as well, and you add the internet and big platforms selling things that were available from far away, low shipping costs with giant container ships, meaning that you could order something and it could come from far off around the world. You could have it fairly quickly and you could have it fairly inexpensively, and in some cases remarkably inexpensively.

But something else to note is the politics of all of this. Let’s just start right here in the United States, we’re used to clean-cut political issues. We’re used to having the Democrats on the liberal side to the Republicans on the conservative side, and we’re pretty much accustomed to a lot of issues just falling out that way. So you have a liberal Democrat, well, you can predict an awful lot, indeed I would say still comprehensively most of what that candidate or officeholder is going to represent. Similarly, a conservative Republican lines up in very predictable ways. The polarization that is a part of the cultural conflict in our nation over the last several decades, has produced a pretty evenly understood contrast when it comes to the left and right in the United States.

But there’s some issues that don’t work out predictably in terms of that polarization, and at least on some economic questions, it is clear that there are some on the right, some who are Republicans, who are beginning to raise basic questions about what’s been known as neoliberal economics, and they’re beginning to ask whether or not it has been good for people. And you also have people on the left who are beginning to ask, at least some are beginning to ask whether some of the economic overextension that the welfare state and the giant administrative state have caused will be sustainable.

Now, that doesn’t mean there’s necessarily any common ground here, but it does indicate that the situation is more complicated than we might first think. Now, all this comes to the fore right now because of legislation and eventually it’s going to draw in both houses of Congress. The big action right now at least immediately appears to be in the House of Representatives, and the question is, what about that big bill, that big bill that the President has called for that will rein in spending and at the same time also bring about a continuation of tax cuts that were enacted during the first Trump term in office? 

Now, there are huge economic factors involved here, some huge worldview factors as well. For one thing, one of the issues that has risen to headline status is controversy over Medicaid. Medicaid is the massive federal healthcare insurance program for those who are low income. They’re defined as low income, and of course that is extended to those who are the dependents of someone who has low income, or a family that is judged to have low income, and this is a program that began in the federal government in 1965 as a part of the Great Society of then President Lyndon Baines Johnson. It was considerably expanded again in 2010 with the Affordable Care Act under President Obama. And so some of the writers said from the beginning that what is really going on here is an effort to try to have national healthcare, basically some form of socialized medicine through the back door, if not through the front door. And the vast expansion of Medicaid funding, and that has come with some interesting developments even during the four years that Joe Biden was President of the United States. These are some pretty pressing issues. 

And so a lot of Republican energy has been towards reforming Medicaid, reining in Medicaid spending and getting people off of Medicaid rolls who are able-bodied. And so as an example, the Wall Street Journal has been making this argument for a couple of years. Just in recent weeks, they ran a major headline, “The Moral Case for Reforming Medicare.” The subhead states their claim very clearly, “Six in 10 Able-Bodied Adults on the Program Have no Earned Income.” So the moral argument being made by the Wall Street Journal’s editorial page, and this has been repeated over and over again with other arguments, has to do with the fact that there are too many people who are on this federal medical care assistance program who shouldn’t be on it. They are able-bodied, they’re able to work, and in the case of able-bodied men, including millions of able-bodied young men, the question is why are they not working, otherwise taking responsibility for themselves and contributing to society? Why are they proverbially, as some have described, in their boxer shorts playing video games in their mother’s basement when they should be working?

But there’s also right now an internal debate among the Republicans and it’s going three ways. Very interesting to watch, and even in coming days, it’s likely that this is going to become even more clarified. So there’s a middle argument. The middle argument is the responsible Republican proposal is that the budget be cut, that federal spending be limited. And by the way, in actual mathematical terms, it is almost never limited. It is just a reduction in one sense of how much expansion might take place. There are some conservatives who are calling for actual reductions. It’s very hard to pull off. Of course, it’s a laudable goal. And so even as you have the central message of the Republican Party being that the party will simultaneously bring about continued tax deductions, and also at the same time will bring about reductions in federal spending, you have some on the right, some budget conservatives among Republicans who are saying, “This isn’t honestly anywhere near far enough. This is grossly inadequate. The proposal that is coming out of the Republican leadership is just not acceptable, not enough. It’s not going to bring about any genuine change.”

You also at the same time though, have another group including some Republicans in the Senate and in the House, at this point it appears more influential in the Senate, who are saying, “I’m not certain, if we are looking at this rightly, we should call for a reduction of Medicare spending.” Now on that side of the argument, there are two interesting moral points being made. Point number one, we do not want people to be medically vulnerable and creating a situation in which more people are medically vulnerable is not good for the society at large. But the second question is what actually leads to a decrease in the need for this federal spending?

And so here are two interesting arguments: number one is you take more people off the rolls, particularly those who are defined as able-bodied young men, and you put them in a situation where they’re not going to get continued benefits unless they go to work and at least make a contribution, et cetera. Of course, even as I would argue, that’s a very strong argument in moral terms, it’s not so clear given the complexities of the federal bureaucracy, how all that works out. 

But the other argument coming along here is, okay, so you begin to take people off of the Medicaid program and then they don’t seek medical care, they don’t go to doctors when they’re sick, and so then you have a mushroom of catastrophic medical situations that show up at hospitals and end up on the tax rolls anyway. So saying you’re going to save money over here, you may well be causing even more spending over there.

But then you have people look at this and say, “Well, that’s exactly what we told you would happen when you create these very large social support programs, then eventually more people get on the programs, fewer people get off the programs, more and more the federal budget goes to these programs and get even defined as entitlements,” and that’s where we are right now by the way. The vast majority of the spending of the federal government is not discretionary even when it comes to Congress. These are long-term programs with long-term obligations, and those obligations by almost no calculation are going to grow smaller. By definition, they’re going to grow ever larger.

So practically speaking, here’s what you need to watch over the next several days. Can the Republicans get any bill through the House of Representatives? Because you’ve got a considerable number of conservative Republicans in the House who are saying, “We’re not going to vote for any bill that doesn’t bring about more actual cuts to federal spending, period. We’re just not going to do it.” You also have a growing number, an emerging number of even Republicans who are saying, especially by the way, those in swing districts, they’re saying, “We’re not going to vote for extreme cuts that are going to be detrimental to our constituents.” Well, it’s very difficult when you look at the numbers in terms of the Republican majority in the House, to know how in the world you can reconcile those two arguments. Speaker Mike Johnson certainly has a giant challenge before him and the clock is ticking.

One final comment on this. It is interesting that a divergence in worldview on the conservative side is becoming apparent here, and this is something we as Christians need to note, we need to note that it’s happening, we need to watch where it goes from here. You have one conservative argument saying, “It’s all about fiscal conservatism. If we continue these ever-expanding programs, we are going to incentivize wrong behavior that’s morally wrong.” On the other hand, you have a number of Republicans and they’re making the argument, “No, we have put people in this economic system in a situation in which there are too many people who are vulnerable and it is simply wrong to cut them off, and furthermore, this is likely just to balloon into larger social, and for that matter, even medical problems.” And so there is an increased number of conservatives who are making the argument that social safety net is not just some giant liberal promise, it is actually something increasingly important for our society.

Okay, that’s a genuine battle of ideas. It’s going to be very interesting to see how much of that translates into anything that comes out in an argument about this bill. But right now Republicans are in the driver’s seat even with a thin majority in the House, and there’s going to have to be a vote and then we’ll see what comes next.

Part II

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Media Speculate About New Pope on Migration? Why the Statements from the Vatican Aren’t Having Much Effect. There is No Serious Policy Proposal

But next, there are some giant worldview issues related to two headline stories, and this is in the first sense a global story when it comes to immigration and migration. It’s also a characteristically American story right now, the problem of homelessness. Okay, big developments on both fronts, big worldview issues invoked here. Lots of interesting things to watch. 

First of all, on the immigration question. This issue has blown up this week for two reasons. The first has to do with the election of a new Pope, and Pope Leo XIV has indicated that he wants to continue the emphasis of the previous Pope, Pope Francis, when it comes to contending for nations having responsibility to take care of migrants and basically a pro-immigration policy, and it was not very defined by the Vatican. We’re going to see more about that.

But the other thing is that you have actual governments, and in some cases, well, for example in the United Kingdom in Britain, the government, even with a Labour that’s a very liberal government, it has had to come back and say it’s going to rethink the entire migration and immigration question because the current system is unworkable. So here’s an interesting development on this front. The election of the new Pope just gives us an historical marker to think about how things have changed. Motoko Rich, reporter for the New York Times offered an article, the headline, “For Catholics, He’s the Holy Father. For the World, He is a Robust Voice,” and obviously looking at the transition with the new Pope. The interesting thing is this: in the article about the new Pope, the reporter in this case recognizes that there has been a vast change in terms of the global conversation on migration and immigration since Francis came to office something like 13 years ago. So if you talk about continuing the policy of Francis, well, it’s going to be very interesting to see how that works.

Here’s what Motoko Rich reports, “As just one voice on the world stage, the Pope’s ability to orchestrate change depends on the global political context. Francis became Pope at a time when there were natural allies, like President Barack Obama in the United States and Chancellor Angela Merkel in Germany, who supported his immigrant-friendly message. By the time Francis died, the world had shifted to a more right-leaning order with Mr. Trump in the United States, Viktor Orbán in Hungary and Giorgia Meloni in Italy.” Miles Pattenden, who is an historian at Oxford University, spoke of Pope Francis and said, “He missed the zeitgeist that migrant issues are more complicated and there are trade-offs.” He went on to say that if the new Pope, “Carries on and just keeps saying what Francis did, he will become more and more marginal.” I think that’s a very apt, a very accurate statement.

And one of the frustrations I’ve always had is when you have a Pope making statements on an issue like migration or immigration, they pontificate, literally in this case. They offer a pontifical opinion moralizing on this issue, but they never have to say exactly what they believe the right policy should be. And so governments actually have to operate by policies, and so the prime minister of the UK, Keir Starmer, who is of course head of a Labour government, a liberal-leaning government there in Britain, he has to answer to the British people, and the British people are saying, “We do not think our current immigration policy, the current policy in terms of migration to the United Kingdom is sustainable.” They’re putting political pressure. When you have someone like Keir Starmer, head of a Labour government saying, “We’re going to have to start restricting immigration,” folks, that’s a major turning point.

And the election of Donald Trump in the United States reflects exactly the same impulse. And so even when you have the Trump administration taking rather draconian action, the fact is that the vast majority of the American people are clearly in support of the White House on this issue, which is one of the reasons why virtually no one, no major figure, even in the Democratic party is going out on much of a limb on this issue. The numbers in the population are just really clear.

But from a Christian worldview perspective, this also raises some interesting questions, what exactly are the moral issues involved here when you talk about migration and you have movements of people from some parts of the world to other parts of the world, and then of course you have some defined as economic refugees, some as political refugees, and then you have patterns of immigration that any honest person would say are basically just commercial. They’re about economic issues rather than about threats to human life and human dignity. All this gets mixed together. You take a group like the United Nations, you would think their job is to mix these things up. Moral imperatives cited all the time with no particular guidance that’s helpful at all when it comes to policy. In the United States, we have administration after administration that has failed on this issue, and that leads to a lot of frustration.

That’s one of the reasons why Donald Trump was elected to a second term in office. It was because a considerable percentage of Americans were so concerned about the migration and immigration issues, and especially an uncontrolled southern border in the United States. The fact is that President Trump knows he has the vast majority of Americans behind him on these issues, and it is interesting. This is a global phenomenon. It’s really interesting that that professor at Oxford University points out that if the new Pope simply keeps offering the platitudes of the old Pope, he is going to recognize no one’s listening.

But as a Christian, I want to acknowledge it isn’t really clear what specifically should be the boilerplate Christian approach to these issues, and it is because they are so complex. For one thing, you can have some people who will say, and some people on the theological left, and you hear some, I would say just Left-wing evangelicals say, “Well, it’s our responsibility to take care of migrants and to do this and to do that.” The problem is that incentivizes even more people to come into a system in which, frankly, there is no assurance that they will be better off. Furthermore, you also have the existence of nations and politically identified as nation-states, and I do believe their first responsibility is to their own citizens in terms of safety, security, order, and yes, the adequate foundation for sustainable life. And the fact is that just incentivizing people all over the world to move all over the world for reasons that in many cases can’t even be documented, creates a problem that is likely to result in a lot more, much greater human suffering rather than less.

You can pontificate from the Vatican, that doesn’t change the situation on the ground. And to be honest, an awful lot of politicians on the ground, and this includes both in the United Kingdom and in the USA, they have learned that if you listen to those voices, you miss the voice of the voters, and that means pretty soon you’re out of office. But again, I have to come back and say just from the perspective of a biblical worldview of Christian ethics, it is not really clear how you can have some kind of massive policy that’s going to fit all these situations. The reality is that we live in a broken world, and this is a part of that brokenness, but it is also clear that most citizens of nation-states understand that the preservation of that nation-state is a legitimate end, and I think even looking at a global phenomenon, it doesn’t make sense that we incentivize people to leave everywhere in the world to go anywhere in the world because they might think it would offer a greater opportunity. That just doesn’t work.

Part III

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Let’s Talk About Homelessness: Democrats are Shifting on Homelessness, Some Now Calling for a Ban on Homeless Camps

But the other issue I wanted to talk about is homelessness, and this is a domestic issue in the United States. It is found elsewhere, but laws of different nations relate to this question in different ways. So in this case, in terms of worldview consideration, I want us to just think about the United States of America and we have a homelessness problem in the United States. It’s disproportionate. For instance, did you know that one half of all the persons who are probably rightly defined as legally homeless right now are in the state of California? And so one state, about half of all the homeless. So the problem is going to be more acute in California than elsewhere.

Okay, ask a quick question. Why does California have about half of the homeless population of the United States? Well, the answer to that’s pretty easy, it has a lot to do with climate, but it also has to do with political climate. It has a lot to do with the fact that it’s easier just in climatological terms to be homeless in much of California than in other areas of the country, but it’s also true that in political terms, it has been quite advantageous to be homeless in California, and this has led to social disintegration.

The Christian Worldview affirms that one of the most primary responsibilities given by God in the gift of government as a part of creation is to establish order and to execute justice, to uphold righteousness, and when you look at homelessness, you see where a lot of governments have simply abdicated that responsibility. You go to places, even as famous as San Francisco, and visiting San Francisco used to be a big thrill, but increasingly, the problem of homelessness, particularly in the downtown area of San Francisco, it has led to a situation in which you never know who you’re going to step around or what you’re going to step in, and it leads to a situation in which, quite frankly, disgusting things are happening that just are not conducive to, let’s just say, tourism or to that matter for downtown business, which is one of the reasons why even an iconic company like Nordstrom there in San Francisco is pulling out of the city center.

All right, so let’s just consider the Democratic Party in this case. There is a big debate in the Democratic Party over these issues, and the interesting person to watch here is the Democratic governor of California, Gavin Newsom, who clearly, just in case you didn’t get the message already, would like to be the next Democrat at 1600 Pennsylvania Avenue. He sees himself in the White House, and we’ve seen him start a new podcast talking to the conservative figures.

Here’s a headline for you, the New York Times, “Newsom Presses Cities to Ban Homeless Camps, Escalating a Crackdown.” Now, again, the article is very interesting. Shawn Hubler is the reporter in this case, and it’s not just Gavin Newsom, it’s not just about his national aspirations. It’s also about the breakdown of order to the extent that the governor of California is saying that cities and local governments there are going to have to get with the program and crack down on homelessness and apply the law, which says that you just can’t camp out in public space with everything that entails. The New York Times tells us, “California is home to about half of the nation’s unsheltered homeless population.” By the way, let’s just stop there. Rather than homeless, now you have “unsheltered population.” That’s a shift in moral terms. Back to the article, quote, “A visible byproduct of the temperate climate and the state’s brutal housing crisis. Last year, a record 187,000 people were homeless in the state according to the Public Policy Institute of California. Two thirds were living unsheltered in tents, cars, or outdoors.”

The next paragraph is interesting, “Mr. Newsom cannot force cities to pass his model ban, but its issuance coincides with the release of more than $3 billion in state-controlled housing funds the local officials can use to put his template in place. The call to outlaw encampment statewide by one of the best known Democrats in the country suggests a shift in the party’s approach to homelessness.” Yes, it does. It probably reflects a shift in Governor Newsom and his own political calculation. It might also be something dawning on national Democrats, which is why at least at this point, very few of them have jumped on the bandwagon to oppose this kind of policy. Once again, we see the evidence of what it means to live in a broken world, but we also understand that policies have impacts and policies come with moral dimensions.

If you have, let’s just say, a very lax policy on homelessness, do you increase indolence? Do you increase bad behavior? Do you incentivize persons who do not intend to work and for that matter may be suffering from any number of issues that make their economic viability doubtful? Are you incentivizing them to camp out in the middle of your city or are you seeking to disincentivize that?

And by the way, what would be the Christian perspective on this? Again, it’s complicated. It certainly has to start once over again with the issue of rightful order. You cannot have a functioning civilization if you incentivize and allow for disorder. Furthermore, if you incentivize not working, guess what you’re going to get? More not working. If you incentivize living in the middle of a park and begging people for money, then guess what? More people are going to move to your state to move to your town to sit in that square and ask people for money.

One of the efforts in previous decades was to try to medicalize all of this, but that hasn’t worked out very well either because at heart it’s not a medical problem. No doubt some people are suffering from very serious medical situations, and also psychiatric situations, but here again, our society decided that the way to deal with such persons was no longer to institutionalize them in facilities, but rather to, well, take another approach, and at least in part, the homelessness crisis is a result of that approach. Policies, they come with consequences. One of the bottom lines here from a biblical worldview, I think, is that if you don’t have requisite order, you can’t help anyone. If you do not have a functioning government, you can’t sustain the community.

If you don’t take care of just basic principles of morality, including, for example, a work ethic, guess what? You subsidize bad behavior. If you pay people to do the wrong thing, guess what? You’re going to have more people doing the wrong thing. At the same time, Christians understand there are some who are genuinely needy. There are some persons who are genuinely desperate, and certainly we want to be a part of offering aid to persons, even if that means a temporary aid to get them into a better situation. But the point is, the problem as it has escalated into what it is now, can’t be reduced to genuine need. It has become, however, a genuine political problem. 

One final thought along these lines, things just might get desperate enough that there is an honest conversation about these vexing questions in the United States, maybe even in the United States Congress. That’s a lot to hope for, but at least I guess that’s what we’ve got to hope for.