Welfare Reform: a Matter of Justice
	Medicaid. It is the United States Federal Government program to aid states in providing health care to the poor and impoverished who otherwise could not receive 	proper medical care.  In 1995 the federal government spent a total of $77.4 Billion on Medicaid.  This is up almost 300 percent from $20.1 Billion in 1984, only 10 years earlier.  In the same 10 years state spending on Medicaid rose over 250 percent from $16.5 Billion to $58.2 Billion.  Under the current Medicaid programs, Medicaid spending will increase at an annual rate of 10 percent, to an estimated $262 Billion by the year 2002.
	Medicaid spending has grown much faster than the general rate of inflation.  For the Federal Government, Medicaid expenditures have grown from only 1 percent of the national budget in 1970 to over 6 percent in 1995, while state expenditures went from 8.1 percent to 13.5 percent in the same time span.  This increase can be attributed to multiple factors.  First, through a series of mandates, the Federal Government has expanded the eligibility for Medicaid, requiring states to serve more people.  They also increased the standards required of nursing homes.  This led to higher nursing home costs which were passed directly back to the Medicaid program.  The current average cost to care for a patient in a nursing home is nine times greater than that of a single dependent child.  The price of medical care, in general, has drastically increased.  Expensive new technology and procedures are a large part of this increase.  The need for these costly new technologies is not expected to decrease, the cost will just be passed on to the public through higher prices and higher Medicaid spending.  And finally, an estimated 10 percent of Medicaid payments is wasted on fraud.  This is mostly fraud by health care providers, with a minuscule amount from patients with forged documents.  
	From 1985 to 1993 Medicaid enrollment has gone up 53 percent.  In the early 1970's, Medicaid recipients were at 8 percent.  Today more than 13 percent of the U.S. is receiving Medicaid's assistance.  If there was no Medicaid, current cuts in employer sponsored medical coverage would have increased the uninsured population from 41 million today to an estimated 50 million people.
	The politicians are finding themselves in a complete catch-22.  If they try to cut Medicaid spending, they fear they will appear cruel and insensitive to the poor and disadvantaged voters, and also voters who sympathize with their plight.  But if they don't try to cut spending, they will be criticized for not trying to cure our current budget deficit.  But while our elected officials sit on the fence, trying not to offend anyone, they alienate everyone by not acting while this Leviathan digs us deeper and deeper into debt.
	In his Justice as Entitlement theory, Robert Nozick describes his view of social justice.  He states that aside from nontransferable natural rights like life, liberty and happiness, justice is to do with holdings, and that government is to have as small a part in the lives of its citizens as possible.  This is his idea of the Minimal State.
	Justice as Entitlement, as he puts it, has three major parts.  First is how people acquire their holdings, Justice in Acquisition.  This states that if a person acquires their holdings by their own labor, without violating the rights of others, then this holding is just.  It is each persons responsibility to work to support themselves and their families.  Next is the idea behind transacting business, or Justice in Transfer.  This principal states that if a person gives something of their own free will, then this holding is also just.  These are the only fair, reasonable, just ways for a person to acquire anything.   Any other way, and the holding will be considered unfair.  Finally, there needs to be a way to correct unjust holdings.  If a person can provide proof that their holdings have been taken unjustly, then the holding is unjust and reconciliation can be made.  However these must be specific claims with specific proof of specific actions.  
	Next, the Minimal State is Nozick's idea of what a government should, and should not, be.  He states that government has the obligation to protect its citizens from theft, force, fraud, and also to enforce contracts.  He states that any more extensive a government will violate its citizens natural rights.  He also says that a government must not prohibit activities of its citizens for their own good or protection, and it cannot  force any citizen to aid another citizen against their own will.  
	With these two major principals we can determine, basically, what his views on the current plans for welfare reform.  With the Minimal State principal, we can clearly see that in Nozick's view, the state has clearly overstepped its bounds.  It is forcing U.S. citizens to pay taxes that will directly be spent on medical care for impoverished citizens.  Many are paying against their will.  Some citizens think that the health care of these people should care for themselves or be cared for by their families.  which leads to his Justice as Entitlement principal.  These needy people are receiving money, or holdings, from the state.  They did not work for this, it was a transfer from the taxpayers of this country.  Since many feel that this is not their responsibility, it is against their will that this money is spent on caring for financially challenged individuals and families.  I believe that Robert Nozick would consider the entire Welfare system to be unjust.
	The American philosopher John Rawls, however, has a far different idea of social justice.  In his theory of Justice as Fairness, Rawls states, like Robert Nozick, that every person has inherent rights to basic liberties.  These include life, freedom, happiness, all nontransferable, and the one transferable liberty, the right to hold property.  But from there, their views differ.
	One of the main points in the Justice as Fairness theory, is the Principal of Difference.  Rawls states that all positions within a society should be open to all.  Everyone should have an equal chance of getting to any position within reason.  He also states that wealth should be distributed to everyone based on their contributions.  The owner who puts up capital for the business, the manager who has the knowledge to make the product, and the laborer who puts in the hard work and effort are all entitled to their own portion of the wealth that has been created through their concerted efforts.  He also states in this principal that disadvantaged people should be given compensation if their needs require it.  Many people work hard and still can't make ends meet.
	In the U.S., the poor are disadvantaged in more than one way.  The higher education required by many professions are beyond the means of most.  Not only can they not get the education to be competitive for jobs, they are exploited by the employers who may not be compensating their hard efforts fairly.  These problems should be dealt with by the government.  They should provide for the needs that the disadvantaged incur that they can not take care of for themselves, especially something as basic as decent health care.  The current programs are not enough, there are many people going untreated, and now they want to cut funding, this will prove fatal for some people.
	In these tough economic times, times of downsizing, layoffs, and cutbacks, the people who continue to be hurt most are the poor.  With funding for education being cut, they have less of a chance of being competitive in the current job market.  They are unqualified for the higher paying jobs that haven't lost medical benefits.  Nor can they afford personal health insurance with the meager wages they earn.  
	These hard working men and women, their dependent children, and their convalescent parents also need medical coverage.  They need x-rays, chemotherapy, to have babies, tonsillectomies,  infant immunization, and nursing home care.  If current plans for Medicaid reform are enacted, many will loose even this last chance to receive decent medical care.  
	John Stuart Mill's theory of Utility states that an action is good if it produces the greatest amount of  happiness for the greatest number of people.  While all U.S. taxpayers would like to close the budget deficit within the next six years, most would not want to see the elderly, expectant mothers, and especially children, without acceptable medical care.  Under this philosophy, reform would be preferred, and greatly appreciated, but not at the cost of these innocent peoples health and lives.
	Using Immanual Kant's theory of the Categorical Imperative, one can get another view of whether we are doing the right thing.  The categorical imperative states that if you take any action and universalize it, make it applicable to any person in the same situation,  and it remains acceptable, then this action is good.  If someone had the means and was given the chance to aid another person who desperately needed it, would there be any circumstances in which it would be good not to offer your assistance.  No rational human could refuse such an act (if they were using the categorical imperative to judge by).  Medicaid is just a centralized system of doing just that.  Even though it's not working to its best possible effect, could anyone refuse to take part?
	People, in this country, need to overlook their own greed.  If they see that the money they work hard for is going towards bettering human life, even just one, I believe that should be reward enough.  I don't believe that my money is being used to its best extent in respect to Medicaid.  There needs to be major reforms in the way money is apportioned and used.  There also needs to be a decrease in the need for  Medical.  Through incentives to businesses for providing health coverage to applicable employees, i think that this is an attainable goal.  The current state of the Medicaid program is grim, but what would be the state of our nation without it.