The Bootstrap Con: How "You're On Your Own" Was Sold to Keep Us Apart

Most of us were raised on some version of the same idea.

You work, you earn what you get,

and nobody owes you a ride. Pull yourself up by your bootstraps.

It sounds like advice from a grandfather who fixed his own truck,

right? In eighteen thirty four,

a paper called The Workman's Advocate used it to make fun of a guy named Mr Murphy,

joking that he could now hand himself over the Cumberland River for the

By the straps of his boots. It was a joke.

Go ahead and try it. Grab your laces and pull up hard and notice that your body

stays exactly where it was. Because the phrase was invented

to describe something that a human body cannot do.

For most of the eighteen hundreds,

it got filed next to other absurdities like sitting in a wheelbarrow

and trying to wheel yourself. Then around 1922,

the joke turned into a compliment somehow.

The impossible thing became the standard.

On july fourth, twenty twenty five it became paperwork.

Under the law signed that day,

starting in twenty twenty seven,

a Medicaid expansion adult between nineteen and sixty four years of age

has to prove eighty hours a month of work or qualifying activity

to keep Medicare and Medicaid coverage.

When Arkansas tried its own version in twenty eighteen,

More than 95% of the people it targeted were already working or should have been

exempt. And about 18,000 people lost their coverage anyway.

In Georgia, the program lawmakers still call the model spent twice

as much on administration as they did on care.

So how did a joke about something nobody can do become the test we give

to a person who needs a doctor?

And who gets paid to give it?

Welcome dear listeners. This is the Overlap.

I'm Will. That's Joshua. Say hi,

Joshua.

Hi Joshua.

There it is.

And today is about a phrase you've probably heard sometime around the kitchen table,

or maybe when you're eating one of those life lessons from your parents.

Phrase that for about ninety years meant,

Hey, you're describing something impossible.

That's genius.

Right, in one line, it's a joke about an impossible act turned into a moral test,

and that test becomes a Medicaid rule in twenty twenty seven.

So hopefully by the end of this podcast you'll know what Georgia spent

on paperwork for every dollar it spent on care,

and which companies are getting paid to grade that test.

And you might be wondering at this point why we're telling about talking about

a 200-year-old joke. But the fact is,

well, I would say nothing broke this week,

but I'm not sure how much first all there is left to break,

~ or that nothing broke. But there would there's nothing urgent that

we would need to talk about immediately to make you aware of.

So we're doing it because states are signing these contracts right

now that build the systems that will check those 80 hours,

and every six months they'll recheck.

Right. Georgia is is kind of at the forefront of this,

right? The goal was twenty five thousand enrollees out of two hundred forty

six thousand that were eligible.

So after eighteen months it had about sixty five hundred.

So I guess we can

That's

kind of start with a little bit of a a gut check,

right?

Okay.

What what is your first reaction to this idea,

this concept, Will?

This idea that able bodied adults should work for their benefits?

~ I mean at first it sounds plausible,

right? I mean it sounds like, well,

I mean, they're getting something if they can get back,

they should. But I guess ~ the reality is nobody's in that situation by choice.

You know, and so I'm not really sure,

you know, first of all, where does the number eighty hours come from?

Where where does that become the the line?

You know, it's it's one of those things that sounds good when vaguely stated,

but when you actually put it to pavement,

I'm not sure it may it passes the test.

Yeah, I I kind of I kind of feel the same.

I also think i i it it really comes down to this idea that we have sort

of co-opted our employers to provide health care,

right? And so for people who are on Medicaid,

either their employer doesn't provide it and they're working full time just like

the rest of us, right? Or they can't afford it because they're

not getting paid enough to actually afford healthcare and so they're on Medicaid.

Or worse, they they have an injury or ~

~ a a disability that keeps them from working in a in a on a regular pace

or at a regular clip or holding down a steady job and so they also need

to be kept alive through healthcare,

through basic needs that any other human being really has.

Right. And if like you said, they're if they're already at work,

I mean what is working for their benefits?

How's that different and why does it you know,

if they're they're already doing eighty hours a week,

it's like, well, okay, now you deserve Medicaid somehow.

~

Right.

What what I I kind of pulled in from this that I thought was interesting

was the whole ~ not just eighty eighty hours,

right? It can of work, it can also be ~ other programs or other systems.

Qualifying activity. Yeah.

~ I

looked a little bit into that here in Oklahoma and there is ~ two

or three ~ work Oklahoma projects programs that are ~ allow you to to to

participate in a thing for at least 80 hours a month.

Wha a couple of them are nonprofits.

You could so you can also apparently go to like a church,

right, and get them to sign a form that says that you did volunteer work

for 80 hours a month. ~ there's also a

an actual like state work program where it's sort of like day labor where

you can you be kind of picked up.

And you don't necessarily get paid for it.

I mean, but you can get paid for it.

If you're working directly for the state,

you don't get paid for it. It's just like a a program.

But you can be paid for it. And if you just have a standard job where you're working

at least part time, I think that's where the eighty comes from,

by the way. At least in the Oklahoma program,

is that forty hours a week times on an average four weeks is a hundred

and sixty hours and they build a year of labor around twenty eighty.

So a half a year of labor, I guess they

they consider to be at least part-time.

Anything less than that is considered a hobby.

That's where I think the 80 comes from.

But I think for a lot of people,

this is just gonna be just another hurdle that they have to jump through

in order to receive something that I mean I personally think should just

be single payer. Like I think we should have healthcare and our taxes should

be used to fund it and it be not for profit within the United States.

But this is just another hurdle

that now people who literally either can't work,

don't work, and they have to figure out h what they can do for eighty hours a month,

or they're they're not making enough money to afford health care.

And we're telling them we have to they have to do more than than they're already

currently doing in order to to receive health care that's provided

by our ability to care for one another.

Well it should be an exciting episode.

Let's let's go ahead and turn to the meat of it and maybe we start with

the joke or the the saying turned upside down because it tells us exactly what

the phrase was built to describe.

Alright, in eighteen thirty-four,

so almost two hundred years ago,

~ the workman working man's advocate,

~ of course, you know, that's a dated name right there,

right? The working man's advocate mocked the Mr.

Murphy, who could supposedly hand himself over a barnyard fence by his bootstraps.

Popick and Zimmer call it the earliest known use.

So this is you know, sort of back in the history of our country and or you know,

some somewhere way back in those days.

And we have the idea that somebody can pull himself over a fence by his bootstraps.

Now obviously on its face that's absurd,

right? ~ it's satirical material,

right? it's a it's an impossible thing to do.

But somehow

And it was seen as such.

that became yeah. But but it's not anymore.

Why is that?

Yeah, I I I mean I I have to be honest,

I think it it kind of comes from this like conservative movement.

It didn't it wasn't until the nineteen twenties,

right? So we're looking at beginning of of ~ or end of World War One,

right? The beginning ~ the end of the the great times,

~ at the end of the twenties where it actually swapped itself around,

right? ~ I think that that that likely was part of a cultural revolution

at the beginning.

It was I mean the whole thing was was a punchline.

It was just like, you know, when you see an editorial in the New York Times,

one of the editorial cartoons.

It was very tongue in cheek. It was very heavy handed because you can't

you you can't fly by flapping your arms fast enough.

It should be put on a mug somewhere.

So it's just kind of a case of like

it's kind of a case of like canky doodle dandy like adopting it and

to empower the the term on your own like people are basically saying,

you know, Hey, the government's asking us to pull ourselves up by our bootstraps.

That's ridiculous. And the government's like,

Yeah, yeah, you should pull yourself up by your bootstraps.

Just own it.

Yeah, I think

they ran out of money. Like they were just like,

Well, we well we don't know what to do,

so figure it out. Do it yourself.

Wow. Well

Right.

I guess that's one way to do it.

I think you know, there was a a North American review ~ in eighteen sixty seven,

so about thirty something years after that original one,

~ that compared a man or it was a foolish effort compared

to a man lifting himself up by his bootstraps,

right? ~ same drawer as as kind of wheeling yourself in on a wheelbarrow,

or getting rich by moving money from one pocket to the other.

You know, I watched that ~ that three stooges bit the other day where he's like,

you know, you owe me twenty dollars and he's like,

No, you know, you or he's like,

I twenty dollars. He's like, No,

you don't, you owe me ten and then they end up handing the money around

and everybody gets paid and they've all

Right.

paid each other back and the same dot it's the same twenty bucks that's been passed

Exactly.

around.

I think I think that that's kind of all part of it,

right? Like moving money between your pockets and calling that progress.

Let's keep that in mind as we as we move toward the the whole Georgia situation.

Right? And then the nineteen twenty two,

right? Joyce Ulysses uses bootstraps for someone who forced their way

up from the lowest rung.

That is ~ it's the OED's earliest example of a phrase the phrase actually meanings

an achievable goal. And so the idea

course that's in

Ulysses, which is a surrealist like novel,

right? I it's not it's not actually meant to make a lot of sense.

Right.

So it's kinda funny that they choose that as the the source material.

Well, I I think it's probably looking back at it more so than necessarily,

you know, it written with that purpose in

Well sure, yeah. But I mean it somebody latched onto that,

right?

mind. Right, exactly. But I I think that that at one time,

right, we did have a ladder. And so it made sense to like well,

I mean really it's just lifting your your leg up,

right? And so w if you lift your leg up you can get on that next run.

The problem is there's no rungs.

Right. So what am I supposed to do but lift myself up to a rung that

I can't reach reasonably?

I'm I'm lifting my arms up here in case you can't see me on this podcast.

Individual descriptor. ~

Right.

yeah, so I I I get what you're saying.

So you're just it's like somehow the context got lost and the idea is that

it sounds like something honorable to like lift yourself up by your bootstraps,

not literally to like pull yourself up into the sky with no nothing to stand on,

but to climb the ladder of success.

Yeah, it's it's to kind of make your own way.

Right. Well, ~ so clearly somebody forgot something in between

the joke originally being stated as like a nonsensical thing that nobody could do,

an impossible task, and then becoming the way that we're you know meant to live,

the the upright, honorable way to live.

Right. So not long after that,

right, nineteen twenty eight, ~ Hoover was at Mad Madison Square Garden,

and he was talking about this this concept of this rugged individualism against

European paternalism and state socialism.

The Depression era obviously arrived a year later,

~ to sort of grade what Hoover was talking about at Madison Square Gardens.

But

It introduced this idea so it goes from from right the eighteen thirties as

a as a joke to you know eighteen sixty seven and it's used again

and specifically as your bootstraps as opposed to your laces or the leather

of your shoes, right? And it's used then again in the twenties

in Ulysses to sort of morph into we're doing this ourselves.

You have to do it you have to do your own y make yourself better on your own.

As though

You could pour from one cup to another.

~ when you don't have the resources yourself to do it,

you can't make more water by pouring it into two cups,

right? It doesn't make two for two full cups,

it makes two half cups. ~ because the amount

Right.

never actually changes. So then

Only one of them's half full. The other one's half empty,

so

Right, so then it becomes this new idea that we have to we have to

do our own thing. We gotta do it ourselves.

Because ain't nobody gonna do it for us and it's and if you if you do,

if we do it for each other, that's socialism.

And so in the in twenty eight,

that was sort of this idea that we have to abandon the concept of socialism

and we have to do our own thing,

this rugged we're rugged, we're tough,

we can do everything by ourselves.

Then the Great Depression hits,

right? Like so and and people

Oops.

right, exactly. It's basically the first time we have rejected

the concept of democratic socialism.

He doesn't say democratic socialism,

but he he calls it paternalism and state socialism.

And literally as soon as we abandon that we we come into the Great Depression,

as though we somehow need to lift ourselves up by our own bootstraps.

~ then

Or as if

Hoover spoke a little bit too soon.

Right. Then of course, fast forward a little bit further,

by about fifty years, right? January of nineteen seventy-six,

Reagan ~ comes into the into the scene describing a Chicago woman with

eighty names and thirty adj addresses,

collecting a hundred and fifty thousand dollars a year tax free.

And so that's his that's he he came up with the welfare queen idea,

right? He created this this whole

So we go from not really being a possible thing to being

a a more it's all about what you can do for yourself.

You have to self improve, regardless of whether or not you have

the abilities financially, mentally,

morally, ethically, whatever, into this welfare queen

who now has managed through state socialism to get free money

by claiming different names and different addresses and

not doing any work for it. ~ the person that was actually affected

by this was ~ was Linda Taylor.

That's he who's describing a specific person,

which I think is interesting. ~ now the the Chicago Tribune was the

one that called her the welfare queen,

not Reagan. He just brought it to the national stage as like a this is a thing.

So Josh Levin ~ of the ~ actually said she was real.

So this was based on a real person.

For one thing, she sounds fairly industrious to come up with eighty names

and thirty addresses and cash all the right checks and get all that sorted

out every month. But

Right.

but seriously though, I mean, you know,

this is there's a a saying in in the legal world that's ~ bad facts make

for bad law. Meaning like don't build your laws off of the most extreme cases.

Well, this is exactly one real person with an extreme super extreme case,

right? Who became the image that everybody carries around of anybody that's

on public aid. Like this is what's frozen in your head now,

right? When you hear like

the the person living in the, you know,

the poorer part of town or whatever grew up in a bad bad side of

the street or whatever, bad side of the railroad tracks.

But they're, you know, they're they're doing something they shouldn't be.

Maybe they're enjoying a soda or something like that.

That they just, you know, they're in indulging themselves.

Well that's just the welfare queen over there living high on the hog with my money,

my tax money that I paid.

Right.

And that's of course when it's based on that extreme vision,

obviously you're gonna skew towards things that are not really ~ realistic

for most people.

For sure.

So, ~ the the next idea we're gonna introduce you our audience to here

is the drained pool. which is the idea of,

you know, ~ sort of the I guess a broader expression would be cutting

off your nose to spite your face,

but rather than integrate the public pools in Montgomery,

Alabama, they actually just drained the pool so that nobody could use it.

Like if you know, if the whites couldn't have it to themselves then nobody

was gonna get to use it. And ~ I believe it's a sociologist or

a a political theorist,

Named Heather McGee ~ refers to this as drained pool politics,

which is zero sum racial politics.

Which is zero sum. Exactly. As though

Yeah, exactly.

as though there's not enough for everybody,

so nobody gets any so instead of everyone having a little.

Right, which is not at all what happens with the pool situation.

Like the the image there would be the if everybody went to the pool

and scooped out a cup of water or something and took it,

you know, for themselves to to splash around in.

But that's not what happened. This city the city drained the pool

so that nobody could have access to it.

Rather than have access to less quote unquote less water.

And of course in a pool you don't use up the water.

So it's just the the whole thing is is nonsense like the saying in the first place.

Right.

But ~ once one outlier stands for everybody who needs help,

closing the pool starts to look like the fair thing to do,

right? If everybody if everybody on public benefits is a welfare queen,

then the fair thing to do is take it away from all of ~ right?

Which brings in the law.

Right. ~ so we have ~ replacement of laws,

the the original law dealing with federal benefits was ~ replaced

in nineteen ninety six by the current law,

which is a block grant with work requirements and time limits.

And ~ it turns out that that law

was re reached a shrinking share of families who are in need.

C B P links it to more children in deep poverty.

So we can build the pattern now from eighteen thirty four to nineteen ninety six,

and we see an impossible standard,

right? Lifting yourself up by your own bootstraps,

becoming recast as the test of the individual.

You know, the person who has character ~ will,

you know, give back to the community,

will work hard and somehow better their community while they're getting

the benefit of public ~ public funds.

So who benefits when failing this test looks like a character flaw?

Is the question.

Right. So essentially pull yourself up by your bootstraps now means

to to do something that you are required to do.

It's a personal responsibility of your own to make a better life

for yourself using no publicly pooled resources.

Basically invented out of thin air and give yourself a better paycheck.

You can see it echoed now in a lot of sentiments who say,

Well, you know, you just need to get a job and do it for yourself.

It's like, Okay, but I looked around and I have a job and I'm working

two of them and none of them provide healthcare benefits and the salary

is not enough to cover both is not enough to cover health benefits for just me,

let alone my family. And so they say,

Okay, well, then you need to not buy lattes and you need to not have a family.

It's like right, but I already have one.

Like I because I was promised that if I lifted myself up by my bootstraps,

I would have a better life, but I can't materialize a better paycheck.

In the real world.

Right. Well that's that's the the basic idea.

So now we're gonna see what that ha what happens when this test is turned into

a form for someone to fill out and complete.

~ the way this test is gonna work,

we're gonna use the example of Adrian McGonagall,

age forty from Pea Ridge, Arkansas.

~ worked at the shipping department at Southwest Poultry,

~ but had Adrian had no health insurance from his employer.

Judge Bosberg, ~ is gonna be the the sort of case the

author of the court case we're looking at,

opened his twenty nineteen opinion with the the account of Mr Adrian McGonagall.

~ looking at Arkansas, June twenty eighteen was the first state

to implement a requirement of twenty hours a week for adults ages thirty

to forty nine. ~ it makes me both sad and kind of encouraged that I'm

on the upper I'm approaching the upper limits of that.

But regardless, ~ so when they require when they implemented this requirement

in twenty eighteen in Arkansas,

about eighteen thousand of the roughly one hundred thousand people ~

who were targeted with this law or but lost their coverage.

They no longer had

Right.

access to health care.

Yeah, and and Harvard researchers in the New England Journal ~ said that more than

than ninety-five percent of these people who were targeted were already working

or should have been exempt from the working requirements for either

the fact that they had a an an actual job already,

or they did not have the ability to work.

Right? So there were no job gains that they could

Could find in Arkansas at the time.

They basically built a machine to catch people who weren't working,

then pointed that exact machine at people who were working and caught them anyway.

In a lot of the same ways that you know,

I see a lot of parallels with the ICE situation that's happening right here

in the United States right now.

They built this machine to point at immigrants and now they're just pointing

it at Americans because they've run out of immigrants?

I'm not sure.

Maybe they're it's too hard to catch They actually find people that

are breaking the law. But yeah,

so ~ I guess the the to kind of clarify a point here,

Mr. McGonagall was working enough to qualify for Medicaid.

It wasn't that fact, it was the fact that he didn't follow

the procedure perfectly to the letter that that led it that put him

in the situation he was in, right?

And they make

these procedures difficult on purpose.

Yeah. Exactly.

It's like you

didn't fill out one box on a farm or make one check or you know,

have the have the ability to go through it enough times with a legal degree

to understand the legalese of all of it.

Another another example is Charles Gresham.

Now, he didn't work. He had seizures,

basically, that made work hard to find.

And when he could get a job, he had trouble keeping it because he was seizing

on a regular basis. The state website

was the only place that you could report your hours worked in order to stay covered,

right? And so he had trouble with the website.

This was 2018. This was an an older gentleman he who also had a

an ongoing medical health problem that kept him from being able

to access a computer. Now he presumably would have to have a computer at his home,

have the availability to use maybe his phone to fill out this form.

Or he could, I guess, go to a public library and do it,

but in order to do so, he'd have to have transportation.

You know, he had to ~ walk, presumably,

while maybe suffering a seizure on the side of the road and getting hit by a car.

There's so many things here, right?

But he was the lead plaintiff in the Gresham versus Azar,

which is the Southern Law ~ Poverty Law Center's National Health Law Program,

Legal Aid of Arkansas. In February 2020.

The D C circuit actually affirmed that Health and Human Services Secretary Alex

Azar's approval was arbitrary.

And that led to what outcome?

So the federal version, which passed in twenty twenty five,

~ when when Donald Trump came back into office,

it passed by literally one vote in the House,

two hundred and fifteen to two hundred and fourteen by a tiebreaker margin

in the Senate, fifty-one to fifty.

Like literally by one margin in both houses or b or both ~ institutions.

And Trump signed it on the fourth of July,

right? So this expansion approves adults.

19 to 64 makes them prove that they have worked 80 hours in a month unless they're

exempt starting in 2027. The exemptions are not quite clear,

but also eligibility will be rechecked every six months.

so nearly two-thirds of adult Medicaid enrollees already work,

according to Kaiser Family Foundation's health news.

The brief doesn't really name a sponsor or

Or a committee or you know, member by member vote.

So Trump signed it. You know,

Kemp's program is sort of the model.

Azar approved it for Arkansas.

And the FGA defended the policy at the Supreme Court.

This is happening. It's going to happen all over the country.

Every state has to figure out a way to make this work because regardless

of what state you're in, they might call it a different thing.

In Oklahoma, I think they call it Sooner Care.

~ in Iowa they call it Buckeye Care.

That i it all has a different name,

but all of these are funded by federal sources.

So when the federal law is made,

all of the states will eventually have to comply with it.

Well, so we've basically taken a law that was already questionably working,

~ arguably not working in the first place and expanded it to go nationwide.

Yes. And Sarah Huckabee Sanders used it as an example for the nation

of what we should use because it worked in Arkansas,

when really their definition for it worked was that less people

Right.

are on it. It's like right, you're letting people die because they can't

get access to health care, even in a situation where they can't afford

it themselves because of the economy of the state of Arkansas,

and you're gonna make that a a national thing.

The

Right.

It works. It's kinda like in the words of Inigo Montoya.

You keep using that word. I don't think it means what you think it means.

Right. And all of this was to basically save three hundred and twenty

six billion dollars ~ from the

the the coffers of the federal government.

~ the Congressional Budget Office sort of breaks that down as nine hundred

and eleven billion in total Medicaid cuts,

~ with the work requirement being the largest single source at three hundred

and twenty six billion over ten years,

mostly just from people losing coverage.

Literally that's one of the goals.

essentially,

like to get the count to get the cuts to what they needed to be,

we need to assume that three hundred and

Regardless of the consequences.

twenty six billion dollars worth of coverage will be lost mostly.

regardless of the of the consequences.

And that means that eleven point eight million people are gonna lose their health

care coverage by twenty thirty four because of this federal law.

And then another five point one million of those eleven point eight

are basically related to policy outside of the bill from its from its own number,

right? So the savings mostly come from poor people

losing their health care coverage.

The budget only balances, in this case,

according to this law.

If people fail to meet the requirement and then have to drop off of Medicaid,

we are basing our budget balancing on whether or not well in this case

not people fail.

Yeah. This is literally an omelet that will require breaking many,

many eggs. ~ so to put it plainly another way,

the question of whether somebody's working enough as it is ex only exists because

coverage was made conditional on answering that,

right? Nobody worried about that until they made it conditional.

And the savings get scored on how many people don't actually answer

in time until they lose their coverage through a technicality.

Right. Which brings us to Georgia.

So let's

yeah, let's go back to Georgia.

Governor Kemp.

So

So

we have the pathways to coverage here,

right? ~ and that's that's gonna cost more than eighty six point

or estimated it cost more than eighty six point nine million by the

end of twenty twenty four, about three quarters of it to consultants.

Which is gonna be this is where the story gets even worse.

Right. So the government accountability office,

fifty four point two million of that eighty six point nine million

is just gonna be spent on administrative costs of administering the

the proof of work program. Okay?

So qualifies for working in Washington these days.

Right. And only twenty six point one million of that eighty nine

is actually on health care. Two dollars to check whether or not a person

is meeting a work requirement for every actual dollar of health care.

And the GOP lawmakers are still calling it the perfect model for our country.

A actually Senators Warnock, Osof,

and Wyden.

Ask the the government accountability office to investigate in December

of twenty twenty four this exact program for that very reason.

~ I mean, the world's upside down,

right? When when the world turns upside down it's hard to tell.

Everything's upside down, right?

~ so just imagine what it's like to be Mr.

McGonagall, agent McGonagall in this situation,

right? He's working at a meat packing plant.

~ I'm sure he works at least eight hours a day,

if probably not some more time,

and there's probably time on there that he's not compensated for getting

his gear on and getting it cleaned off and he comes home smelling like raw meat.

And you know, when's he supposed to go and fill this this paperwork out?

Well, you know.

Obviously he's not gonna do it during working hours because that's when

of course that's when all the offices are open,

right? So they don't open on the weekends.

So when's he supposed to go? Well well he can just do it online if that's a problem,

right? Well those these government websites,

as we talked about before, are difficult,

notoriously difficult to navigate,

even for lawyers. Like I'm trained to read legal documents

and understand how things, you know,

understand the workflow and these kinds of things.

And it's hard for me sometimes when I open these ~ these pages to figure

out what's going on. So, ~ I mean this is where the the

working man or working person ~ kind of falls off the map,

right? Or falls off the the ledger because they're clearing the way for

~ this model outcome that means that nobody gets healthy care coverage.

But before we get too

I think

comfortable on our side of this,

go ahead. Sorry Joshua.

I was gonna say,

you know, ~ in addition to this,

right, we're assuming that this guy's gonna work a normal nine to six schedule,

right? the library is gonna be closed outside of that.

So in order to be able to access this website,

you have to have access to either a smartphone with with an ~ cell phone service

package, or your own computer that you're maintaining or a tablet

or something like that with internet service.

Right? So if he's working nine to six and a bank's only open nine to four

and the library's only open eight to five.

He doesn't really have the opportunity other than maintaining an expense that

he doesn't necessarily want or need to create a mandate to fill out paperwork

in a form that he's working these hours that he's already clearly working.

And we can see that because he's paying taxes on his income to the IRS,

so we know how much he's actually working,

and how much per hour it's all sent to the IRS.

But now he's gonna have to go to through a separate hoop to submit

all this information and possibly incur the expense of a computer or a tablet

or a laptop or a cell phone and an internet package or a cell phone package

in order to be able to fill out these forms and somehow manage or somehow manage

to go to a library outside of those hours and fill it out there.

Well, it sounds like we've got this pretty well sorted out,

but before we get too comfortable,

let's take a look at the case for the other side and part of that

is a legitimate argument. So ~ let's this take take us back in time

now or forward in time, I figure where we left ourselves.

But we're gonna go to the San Francisco Fed in twenty nine.

And it was there were fears about that single mothers would sink deeper into poverty

after the nineteen ninety six law didn't pan out.

So caseloads fell.

Employment and household incomes rose.

~ you know, there was kind of chaos there.

And the Congressional Research Service reported,

~ report R forty five three seventeen,

welfare to work experiments that paired requirements with job

and education services raised employment and where wages,

right? So this is a study the Congressional Research Service

put together and figured out that this welfare to work experiment

was producing good results, right?

So that's encouraging from that perspective that if you can p p put people back

to work or get them to at least try to work some even while they're on welfare,

~ maybe they can they can make the transition,

right? They can literally pull themselves up by their own bootstraps.

~ the Foundation for Government Accountability says attracted more than

a million adults under the snap work rules,

and many went back to work with incomes more than doubling a in a year.

Now, doubling from welfare checks is

Not as impressive, but hey, it's it's head in the right direction.

And then there's reporting from Levin that that the Linda Taylor case,

right? We talked about the welfare queen already.

Linda Taylor was real. The furs and Cadillacs were real,

and her alleged crimes were well past welfare fraud.

So again, I mean this is again this is a real person,

right? So it's not a made up story.

But it is a very unusual, exceptional individual,

right? And this and clearly a criminal criminal mind.

I don't know if mastermind may be too strong a word.

But clearly a criminal mind here.

There was more than just welfare fraud involved in our enterprises.

And then we get Georgia saying that a two-year launch delay drove part

of the pathway's costs. So they're they're trying to justify why that

$80 million or $89 million, whatever it came out to,

~ saying that a two-year launch delay drove up those administrative costs.

And CMS calls the vendors $600 million pledge-free and discounted help.

So what what that means is the the people that they hired for these that they

allotted that money for just took it as a tax deduction,

right, instead of charging them directly.

So that money they still got their they still got covered for that in the form

of a the tax write off. ~ so where does that leave us,

Joshua? What do we what do we actually believe at this point?

Well, what what do you believe,

Will? I mean, ~ there there are they have legitimate some legitimate return right

here that they that what they were trying to achieve,

some of it happened. I I I guess the w and I want to present it that

way because some of the things that they were claiming absolutely did happen.

I don't think it accounts for the actual human cost in this,

though. Right? Like, ~ yes, we saved some money.

Yes, some people that they tracked under

These same guidelines for literally supplemental nutrition and food assistance went

back to work because of these work requirements and ended up doubling their income

because they went back to work.

Okay, that's valid, but you did it by literally taking away their ability to eat.

And so

Right. mean it's one thing

to say there's positive outcomes from these these kinds of programs.

It's another thing to use those outcomes or use the the one of the steps along

the way as a measurement for whether they qualify for the original care

in the first place. Right. It's like this is basically saying we

can change some things, we can we can help get them on the road

to recovery by putting them back in jobs and getting them ~ earning income.

But if we look if we flip that on the reverse side and say if we set this

as a minimum bar for getting the ~ the federal funds in the first place

That's a good way to clean a lot of people off the the ~ ledger,

right?

Yeah, I think I think if you if you read the if you read the C R S all the way down,

right, the the gains were usually ~ modest.

They were often faded, you know,

and they they didn't really raise incomes unless their earnings were supplemented.

So those programs that they created essentially came with services.

The Medicaid version of this comes with like

a logon and essentially a work requirement.

of administrative paperwork on top of an actual work requirement,

right? The FGA number comes from the FGA,

the same group that filed the Supreme Court brief defending the work requirements.

Other studies actually found s much smaller gains and smaller losses.

Of course they're not going to report those.

They don't stack up to what they were trying to achieve.

The CBPP credits more than more of the post

Nine ninety six gains to a strong economy and the earned income tax credit,

right? So and points to more kids in deep poverty.

All ten pledging vendors already hold state Medicaid eligibility contracts.

It's basically like

And this is

the the first bag is free kind of a sales strategy.

Right. ~ ironic, given that who was driving this.

But ~ yeah, I mean that's that's the classic case of never letting the facts

get in the way of a good story,

right?

So wh wh what have we settled and what's still that issue here,

~ at this point?

Well, so I think Arkansas Arkansas lost their coverage,

right? There was no actual measured job gain in that because there aren't it's

not like i if you increase work requirements that jobs are going

to increase in turn.

And then you have the Georgia case where they spent two to one on just

the actual cost of implementing the program that they could have been just using

toward the actual care.

And so I think, you know, whether or not the nineteen ninety-six

law actually caused the gains,

~ that's kind of the the San Francisco Fed versus CBPP,

right? And then you have this this corrupt company that's essentially tracking

all this information who directly benefits from these facts being true.

Now, what is real is that

Requirements with services attached have actually raised employment ~ modestly,

according to CRS, right? I mean,

so that's a real thing. So essentially when you say,

hey, look, we'll give you more ~ benefits to yourself and benefits

to grow your life, and that might be small things,

right? We we will help you with education to help you get into

a different workforce ~ you know,

that ha is more demanding or ~ has more demand in it,

or you know, we might

If you qualify for SNAP, you might also qualify for Medicaid,

right? Or if you're filling out your SNAP requirements,

which the state of Oklahoma again requires eighty hours a month for

you to have SNAP. But you still have to log it in two places under this

new Medicare law. Maybe they'll combine them,

right? Maybe maybe if you you know,

if they share the information,

if the IRS shares the information with the Congressional Budget Office,

th of

This person is working this much,

maybe we can eliminate the requirement altogether.

But I think that the entire situation is corrupt.

Right?

Yeah.

The the welfare queen story, that's real.

I'll get I'll give it I'll give them that.

That was a real person doing a really bad thing.

But that stuff's already against the law.

It's fraud. We should absolutely try people in a court with real

consequences.

For people who abuse these systems.

I I'm not saying that we shouldn't we shouldn't ~ avoid or that we should avoid,

you know, prosecuting or or keeping fraud out of these these systems.

It's like the getting rid of fraud and waste and all this other stuff.

Yes, we should do those things.

But we should not take actions that would directly cause someone harm in order

to do it. And that's that's almost every turn of these these

policies and these ideas that are overwhelmingly coming out of the

out of the conservative wing of our government are an attempt to cut budgets

at any cost. And I I think that they they failed to understand that there

is a cost to all of this, but it's a human one.

It's just easier to to I guess track on a spreadsheet when it's

a dollar number versus an actual impact on people's lives.

And I I've said this many times personally,

I think that I would rather,

you know, feed forty people that don't deserve

to eat to make sure that a hundred kids who actually need

the food to to actually be able to eat,

right? Like if if that takes me paying taxes to feed forty people

who don't actually meet the requirements,

I'm okay with that. Should we hunt?

Down those people who don't and every now and then audit our system

to make sure we're not doing those things.

Yeah. Right. But it's a lot better

for an administration's claims if they're trying to get re elected,

to say, hey, look at all of the all of these budget line items we were able

to to cut without pointing to the fact that we cut them by stealing literally food

out of children's mouths.

Well, one thing we can ~ sort of confirm or or validate absolutely,

you know, and the one thing that's sort of black and white is the

~ the actual invoices themselves,

right? So we talked about Georgia paying twice ~ two dollars for every dollar that

they recovered. we can actually look to the invoices and see how that came about.

So ~ Luke Seabourne

So let's look at them.

What's that?

I said l I said let's listen let's hear

Okay, sorry. Luke Seaborne appeared in Georgia's own twenty twenty four promotional

video for Pathways. Meanwhile,

red tape has caused him to lose his benefits twice.

And this goes goes back to a little company you may have heard of called Deloitte.

Are you familiar? Yeah.

never heard of Just kidding.

~ so one might wish. But they were paid ~ and Deloitte is generally considered

a consulting agency, but that doesn't really begin to cover what they do.

They do a lot more than just ~ consulting.

We'll get that in a second, but ~ Deloitte was paid more than fifty million dollars

for pathways eligibility software that reportedly often froze

and wiped out applicants' information.

So a fifty million dollar piece of software to do one thing and it it

it couldn't do that one thing.

The contracts

At least not well.

were obtained through at least not well exactly.

the contracts obtained through public records were heavily redacted,

but that's what we do know about the Deloitte deal so far.

So two point four million to write you know,

a shitty app. Over fifty million to build that system,

ten point seven million to advertise that now that system exists.

And during the ad contract, enrollment went from about two percent

of eligible people to under three.

So less than a full percentage point.

Right. Paid to write the test,

paid to build the test, paid to promote the test.

Somewhere in that whole mess,

a sick guy in a promotional video got kicked off of it twice.

And somebody made the decision to put that that specific guy in that situation.

Someone named Deloitte executive,

apparently.

Right, Maximus twenty twenty six this year.

CEO Bruce Caswell's company told investors in August that states implementing

HR one will bring back growth.

They called it attractive new work opportunities.

On its february twenty twenty

Consultants.

six call, it reported a fifty nine point one billion dollar sales babillion

dollar sales pipeline.

fifty nine

Wow.

percent of it was new work including Medicaid and Snap.

Optimum Health, you've heard of them.

If you if you have ever used United Healthcare,

right? The United Health Group,

a one hundred and twenty five point six million dollar Vermont eligibility contract

as of October of last year, covering the work requirement and six month rechecks

~ among other work. So yeah, it's creating jobs.

It's creating jobs by literally harming people.

To to administrate the systems to harm people.

I just like the fact that the when they needed to Yeah,

I l I just love the fact that when they looked they needed to know who

to kick off the the rolls, they turned to United Health Group.

As like, you know, not as insurance expert,

but as an expert on tracking people and making sure that you could find ways

to kick them off.

They have really good systems to kick people off.

Hey, they're using AI to do it.

Exactly.

You know, I mean Charles Gresham,

right, lost coverage over a website that literally couldn't work.

It wasn't that he did something wrong.

He did all of the things, he did the requirements.

It somewhere got lost. This and it could have been something simple.

The save button was not visible.

You had to scroll down, and maybe he's an older guy,

you know, like he didn't see the save button.

So he's like, I filled out all the forms.

I don't know what else to do.

And he exits the website and all that information never

He didn't consent the marketing.

makes it into the system because they had a bad user interface,

right?

Or he didn't consent to be marketed to the marketing opt in and they wouldn't

let him click through.

Right. He didn't read the Eula.

Adrian McGonagall, that guy had a full

Yeah.

time job. He was working in a meat packing plant and his employer didn't offer

insurance. That's literally the people who Medicaid was designed for.

And it's literally the people that they say they want on this system,

but they're adding additional burdens in order to stay on a system that's working

exactly like it was already designed to.

~ and this is this I mean, these are real people that we're talking about here.

And now that it's gone nationwide,

it's gonna be real people that you know,

most likely. If someone at your job has no employer coverage and

is on expansion Medicaid starting in twenty twenty seven,

they're gonna be proving their hours through a system that a contractor

is building right now.

So the question that we we're we're left with really is is like who sits

at the top of this situation, who sits at the bottom?

And once again, I think Will and I probably both agree on this,

it's the people who are already hurting that are at the bottom of this.

Like they're already

Agreed.

unwell, they're unhealthy, they're overworked,

or they're handicapped and unable to work,

incapable of of holding down a job,

not because necessarily their abilities,

but because their ~ their employer's view of their reliability.

Or it could just be something as simple as as someone getting pregnant.

And not having ~ not wanting to to have to pay for their health insurance premiums

and and those sorts of things to to exit them from the system so that they

can share the responsibility with the world while also voting in people

who are taking those things away as well.

The people at the top, they're the obvious people.

They're always the same people.

They're so giant software corporations,

huge, huge money-making ~ you know,

~ enterprises.

That to be fair, they're like,

well, we're just executing, we're helping.

We're we're private companies partnering with the state to help them create what

they what they have put into law.

But we're not really understanding the data that they're using,

and we're we're changing the outcomes of these situations based upon what

the data actually shows.

So

Did you bring home for a landing for us,

Joshua?

Yeah. If you say that the testing measures work.

Then nearly two thirds of adult enrollees

in Medicaid are already working.

In Arkansas, ninety-five percent of them were either working or completely exempt.

And they didn't really create any jobs through this.

So they had to go looking for jobs that weren't there and work them

in order to continue receiving their benefits.

So if if you think it saves money,

326 billion of 911 billion,

it's really mostly from people losing coverage.

Georgia spent fifty four point two million on administration and twenty

six point one million on actually helping people.

So if you think that work requirements can work,

there are only modest gains when we actually look at the information.

The San Francisco Fed found employment rose after nineteen ninety six.

The that was mostly the dot-com bubble,

but the the Medicaid version just attaches paperwork to it.

It's like, well, we just need to track it better.

It means we need another whole system.

If you think that vendors are just doing a job,

these companies are calling these things a growth driver,

which means they're just making gains for the stock market overall.

And ten of these pledging vendors already hold contracts.

If the the well fair queen was invented,

we know she was real, according to this Leven guy.

But we're punishing everyone for one person.

So Georgia's Deloitte contracts came out through public records,

right? Heavily redacted public records,

but you say there isn't one.

public record. You can look it up.

You can go look out online.

So I mean it sounds like we're talking at best nominal gains that are gonna

be a drop in the bucket compared to the number of people that

are eliminated from the system altogether.

And that's where the real money's made,

is the government recouping the the expected forecast costs

for those individuals who do qualify at this time.

Is that fair to say?

Yeah.

I not just that, I also think I I I I hate to make future predictions because

they're they're, you know, fifty fifty wrong.

I think that this is gonna be used in the future because when you when these people

drop, they're it's not like their health needs are gonna go away.

They're just gonna stop treating them.

So if we ever do move toward a better system where we maybe stop prioritizing profit

over people's literal lives or something to that effect,

I think you're gonna see conservatives say

C, we did this and look at how many people are abusing this.

It's like, no, you took it away back then,

and then when we fixed it, we we're dealing with the healthcare issues that fell

out because they fell off.

Like that's that's the con, that's the whole thing,

start to finish.

So we went from a joke in eighteen thirty four to a an ~ admonishment

in twenty twenty or in nineteen thirty,

nineteen twenties, it was an admonishment and now in twenty twenty seventeen it's

a login screen.

That's pretty much it. We're we're all gonna be required to prove everything

all the time, despite the fact that we already have systems in place that currently

will tell you whether or not someone is.

If you even if you believe that it should be the case and that we should have

the all these requirements, why are we passing it on to the person except

for it's just another barrier to put in front of somebody so that they can't

get the things that they actually need?

That's it. That's the whole point of the podcast.

No, I'm sorry to leave you with this this time.

No,

there's no it's just th this is we're just we're just explaining a thing that is.

And it it's it's not just healthcare,

it's a it's a greater it's a greater theme that we're seeing throughout.

Joshua, where can they find us if they want to engage in the discussion further?

Yeah, you can find us on our website,

we're at FOF.foundation. You can ~ rate us on your favorite podcast app of choice,

whatever you're listening to this on right now,

just give us a rating, five stars please.

If you want to send us an email,

you can email us at the overlap at fof dot foundation.

Other than that, I don't know.

Be kind to each other. Help out where you can.

See you next week.

With that, we'll say bye.

Bye.