To state the problem in its starkest terms, one side sees those in poverty as unfortunate victims of circumstances. The other side maintains that, while granting that circumstances are often beyond our control, every individual must bear responsibility for their own life.
The one thing we do know is that as a nation, we're not handling the problem well. This is clear by the extent to which poverty persists and by the huge amount of funds that we spend to bear the direct and indirect costs of it.Medicaid, the federally and state funded program designed to pay for health care for around 45 million of the nation's poor, is a major case in point.
Watching the program is like standing helplessly on the wrong side of a cascading avalanche. You see it escalate and grow, with a sense of inevitability that at some point it is going to take you under.
Spending on Medicaid is now a staggering $350 billion. This is double what it was 10 years ago. The federal portion, which is now over $180 billion, was $14 billion in 1980.
Aside from the alarms that go off from the growing and massive spending, another fact should set off an alarm. That is, at 22 percent of state budgets nationwide, spending on Medicaid now exceeds state budgets for education.
Recognition of this gets us on one important track for thinking about the problem.
Poor health follows from poverty. And poverty follows from poor education.
There is another important theme.
That is that both the way we deliver education to our poor and the way we deliver health care to our poor are 100 percent controlled by government monopolies.
It all converges in the following way.
Take the case of the new HPV vaccine against strains of the virus that can lead to cervical cancer. I've been writing a lot about this because it drives home so many of the mistakes we are making in how we deal with health care and poverty.
As anyone who has been reading about this knows, most states are struggling with the question of whether to mandate this vaccine for preteen girls.
If they do, where is the money going to come from to pay for providing the vaccine to the hundreds of thousands of girls from poor families? Of course. Medicaid.
The state mandates the vaccine and the Medicaid cash register rings, making payments to the drug company supplier Merck for each shot.
But consider that it is reported that, of the 3,700 deaths in the United States from cervical cancer last year, it is estimated that about 85 percent of the cases were women who never got a Pap smear.