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Fragmented Democracy

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For this media project, I found an article in the popular leftist Jacobin magazine. In the article, the interviewer questions Jamila Michener on her work, especially her recent book, Fragmented Democracy: Medicaid, Federalism and Unequal Politics. In this brief report, I analyze Michener’s criticisms of the United States’ health care programs, particularly, Medicaid. According to the government website, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government” (Medicaid.gov). …show more content…

As defined earlier, Medicaid is a variety of distinct state programs funded with federal money. Hence, some state programs are less comprehensive than others as the federal government only standardizes state social policies to a limited degree. This heterogeneity allows for enrollees to have diminished access to care simply because of their place of residence. Since the federal government requires that only the basics are covered by Medicaid, there is provision for different optional benefits. In many cases, as Michener notes, some of these optional benefits such as hospice care are necessary. While states are responsible for deciding eligibility criteria and benefits, counties are tasked with the actual administration process. Thus, beneficiaries face variability problems or challenges even at the county level. Michener describes this geographical inequality of Medicaid as a “product of political choices and resource allocation”. She argues that decisions to allow economic inequality continually spiral out of control render resources devoted Medicaid less effective. She notes that the tendency to avoid big government has led to poor treatment of Medicaid beneficiaries because “States often fail to equip counties to effectively administer Medicaid, and again this leads to poorer health

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