Reducing poverty with the child tax credit but then taking it away is an unappreciated factor in Trump's win. Not Joe's fault that he did not have the votes but still we now all are paying the price.
Excellent, important numbers and analysis of Medicaid use that i havent seen elsewhere. Glad to see that this went as letter back to WSJ. Content probably belongs as a standalone somewhere. I think i’ve also seen studies that kid-care is cost effective - eg, saves more than would be spent without it - ERs for what should be primary care, early interventions for diabetes, asthma, etc., preventing complications.
Cogan’s comments illustrate the Elephant in the Room. Conservatives of his ilk don’t want those poor people on Medicare to live longer lives. They don’t value them in any way because they are not productive to their conservative view of society. No need to spend money on them when that money could be better used for more important conservative agenda items. The discordance of thought here is that those poor people who need the help are also the ones that do all the tough day to day jobs; they provide the glue that holds the daily basics of our society together. Cogan doesn’t appreciate their contribution and value.
I want people less fortunate than me to have healthcare. I want the government to be fiscally responsible that means no frivolous spending on military parades or other unnecessary spending. I want people who fall between the cracks those that don’t qualify for Medicaid and can’t afford regular health insurance coverage to have something they can afford that would at least be comparable to Medicaid or something else like standard healthcare insurance. How can we accomplish this goal? How do we cover all Americans without breaking the bank?
Let's take this analysis a small step further. Universal health insurance would be the cheapest method to achieve improvements in health status. The costs of care would be lowered as a result.
But wait. Single payer health insurance would be even cheaper as the administrative burden would be reduced as well. Medicaid had a 3.9% overhead in 2023. Traditional Medicare had a 1.3% overhead rate in 2018. Even Medicare Advantage (that's the private insurance add-on) had a 14.8% overhead in 2018. Private insurance plans can add 15% to 25% overheads to health care expenditures.
The Germans have a highly regulated system of private insurance with significant protections for low-income people, essentially subsidized health insurance. Their providers are generally in the private sector but provide services based on standard rates for treatments. Therefore, they have come very close to universal health insurance coverage. There are ways that a richer person can opt for private insurance for treatments that health insurers will not cover because they do not promote health (think facelifts just for vanity).
I have my student compare the UK, US, and Germany each term to determine which has the superior system of health coverage. The US always comes in third.
I would like to find more information on how the German “Bismarck” system works. It is not single payer, but relies largely on private insurance pools. That model is also used by Switzerland, Belgium, the Netherlands and Japan and has been very successful. Given how Republicans always try to cut government run programs — and often succeed — it may be better to have a privately run system.
Mr. Cohen has a remarkable lack of empathy for individuals on Medicaid. According to an alleged statement by Dr. Friedman “ failure to optimize shareholder interest is business malpractice “ clearly Mr. Cogan views the United States as a corporation. Taking the analogy of the citizens of the United States being shareholders in a corporation, the United States of America, Mr. Kogan is inconsistent with such a system. I suppose some of his lack of empathy is due to the fact that I would guess that he has never had to worry about his medical bills being paid..
Ok, Cogan... if you don't like the Medicaid health care delivery system, come up with a better public plan rather than leaving Americans to the tender mercies of for-profit healthcare that leaves large numbers of us on the outside looking in.
Our health care system is broken. Really, we have a health insurance system, not a health care system. Tying medical care to employment ensures that many people won't be able to afford health care, and that when you lose your job you also lose your health care. I've lived that. It's terrifying. Fix the health care system and Medicaid goes away. But this assumes that the common good is a good thing. A sentiment that the rich and privileged always disagree with.
John Cogan’s Medicaid screed in the Wall Street Journal is a perfect example of how ideology masquerading as analysis can lead to cruel conclusions. His argument is elegant in its simplicity: Medicaid got bigger, so we should cut it. That’s it. No mention of the evidence—just the tired notion that helping more people must somehow be bad.
But there’s a reason Medicaid has grown: it works. It keeps people alive. It keeps hospitals solvent. It prevents medical bankruptcies. It gives children a shot at a healthier, more stable life. Cogan doesn’t bother to grapple with any of that. He treats 70 million Americans on Medicaid as a budget problem instead of a moral obligation.
The kicker? His fantasy that voters are cheering for these cuts. They aren’t. Even Republican voters—many of whom rely on Medicaid themselves—know what’s at stake. Polls show they’re worried, and rightly so. You can’t eat ideology, and it won’t pay your hospital bill.
And let’s not forget his rose-colored view of welfare reform. Yes, the 1990s economy helped people. But it was the combination of a hot job market and stronger social programs—EITC, CTC, Medicaid expansions—that did the heavy lifting. Strip those away and what’s left? The same tired bootstrap sermon we’ve heard for decades, now with worse outcomes and shorter lifespans.
Here’s the truth Cogan won’t admit: these programs work. Medicaid saves lives. It saves money. And it saves dignity. If that’s a problem for him, it says more about his values than the program’s effectiveness.
Some, not all, rich people boost their self worth by inflicting misery on the poor. Thus the richest man in the world cancels USAID and causes the deaths of perhaps a million poorest people through starvation.
Guys like him — most Republicans — don’t care one whit about economically challenged Americans. They see them as a bunch of whiny losers who chose their fate. “Christian” conservatives are a prime example. Republicans have nothing but disdain for ordinary Americans — including the suckers in the MAGA base.
I will never forget how Mr. “Compassionate Conservative” George W Bush refused to make an effort to inform poor parents of their children’s eligibility for that program because he wanted to run on fiscal responsibility and the more kids enrolled the more Texas’s share of the cost would rise. Most of the media played along with his pretense of caring about the poor and the deficit. The late, great Molly Ivins was one of the few who called him out. She also pointed out that NJ’s Republican governor Christi Todd Whitman had mounted an aggressive campaign to ensure parents were made aware of that program.
Republicans are addicted to Reagan's "welfare queen" kool-aid.
Reducing poverty with the child tax credit but then taking it away is an unappreciated factor in Trump's win. Not Joe's fault that he did not have the votes but still we now all are paying the price.
The price is high.
You may like my stack, Burnt Ground. JosephZeigler.substack.com
Thanks
Excellent, important numbers and analysis of Medicaid use that i havent seen elsewhere. Glad to see that this went as letter back to WSJ. Content probably belongs as a standalone somewhere. I think i’ve also seen studies that kid-care is cost effective - eg, saves more than would be spent without it - ERs for what should be primary care, early interventions for diabetes, asthma, etc., preventing complications.
This guy is right up there with Laffer.
Good essay, persuasive argument. Thanks!
Cogan’s comments illustrate the Elephant in the Room. Conservatives of his ilk don’t want those poor people on Medicare to live longer lives. They don’t value them in any way because they are not productive to their conservative view of society. No need to spend money on them when that money could be better used for more important conservative agenda items. The discordance of thought here is that those poor people who need the help are also the ones that do all the tough day to day jobs; they provide the glue that holds the daily basics of our society together. Cogan doesn’t appreciate their contribution and value.
I want people less fortunate than me to have healthcare. I want the government to be fiscally responsible that means no frivolous spending on military parades or other unnecessary spending. I want people who fall between the cracks those that don’t qualify for Medicaid and can’t afford regular health insurance coverage to have something they can afford that would at least be comparable to Medicaid or something else like standard healthcare insurance. How can we accomplish this goal? How do we cover all Americans without breaking the bank?
Let's take this analysis a small step further. Universal health insurance would be the cheapest method to achieve improvements in health status. The costs of care would be lowered as a result.
But wait. Single payer health insurance would be even cheaper as the administrative burden would be reduced as well. Medicaid had a 3.9% overhead in 2023. Traditional Medicare had a 1.3% overhead rate in 2018. Even Medicare Advantage (that's the private insurance add-on) had a 14.8% overhead in 2018. Private insurance plans can add 15% to 25% overheads to health care expenditures.
Guess what the GOP prefers.
That, and the medical debt industry is huge - https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#Share%20of%20adults%20who%20have%20medical%20debt,%20by%20health%20status%20and%20disability%20status,%202021
The GOP (and likely many Dems) feeding at the trough have very little interest in remedying that and losing a major source of campaign funding.
The Germans have a highly regulated system of private insurance with significant protections for low-income people, essentially subsidized health insurance. Their providers are generally in the private sector but provide services based on standard rates for treatments. Therefore, they have come very close to universal health insurance coverage. There are ways that a richer person can opt for private insurance for treatments that health insurers will not cover because they do not promote health (think facelifts just for vanity).
I have my student compare the UK, US, and Germany each term to determine which has the superior system of health coverage. The US always comes in third.
I would like to find more information on how the German “Bismarck” system works. It is not single payer, but relies largely on private insurance pools. That model is also used by Switzerland, Belgium, the Netherlands and Japan and has been very successful. Given how Republicans always try to cut government run programs — and often succeed — it may be better to have a privately run system.
What do you expect from the Hitler, er, I mean, Hoover Institution?
Mr. Cohen has a remarkable lack of empathy for individuals on Medicaid. According to an alleged statement by Dr. Friedman “ failure to optimize shareholder interest is business malpractice “ clearly Mr. Cogan views the United States as a corporation. Taking the analogy of the citizens of the United States being shareholders in a corporation, the United States of America, Mr. Kogan is inconsistent with such a system. I suppose some of his lack of empathy is due to the fact that I would guess that he has never had to worry about his medical bills being paid..
Ok, Cogan... if you don't like the Medicaid health care delivery system, come up with a better public plan rather than leaving Americans to the tender mercies of for-profit healthcare that leaves large numbers of us on the outside looking in.
Our health care system is broken. Really, we have a health insurance system, not a health care system. Tying medical care to employment ensures that many people won't be able to afford health care, and that when you lose your job you also lose your health care. I've lived that. It's terrifying. Fix the health care system and Medicaid goes away. But this assumes that the common good is a good thing. A sentiment that the rich and privileged always disagree with.
John Cogan’s Medicaid screed in the Wall Street Journal is a perfect example of how ideology masquerading as analysis can lead to cruel conclusions. His argument is elegant in its simplicity: Medicaid got bigger, so we should cut it. That’s it. No mention of the evidence—just the tired notion that helping more people must somehow be bad.
But there’s a reason Medicaid has grown: it works. It keeps people alive. It keeps hospitals solvent. It prevents medical bankruptcies. It gives children a shot at a healthier, more stable life. Cogan doesn’t bother to grapple with any of that. He treats 70 million Americans on Medicaid as a budget problem instead of a moral obligation.
The kicker? His fantasy that voters are cheering for these cuts. They aren’t. Even Republican voters—many of whom rely on Medicaid themselves—know what’s at stake. Polls show they’re worried, and rightly so. You can’t eat ideology, and it won’t pay your hospital bill.
And let’s not forget his rose-colored view of welfare reform. Yes, the 1990s economy helped people. But it was the combination of a hot job market and stronger social programs—EITC, CTC, Medicaid expansions—that did the heavy lifting. Strip those away and what’s left? The same tired bootstrap sermon we’ve heard for decades, now with worse outcomes and shorter lifespans.
Here’s the truth Cogan won’t admit: these programs work. Medicaid saves lives. It saves money. And it saves dignity. If that’s a problem for him, it says more about his values than the program’s effectiveness.
You may like my stack, Burnt Ground. JosephZeigler.substack.com
Some, not all, rich people boost their self worth by inflicting misery on the poor. Thus the richest man in the world cancels USAID and causes the deaths of perhaps a million poorest people through starvation.
Guys like him — most Republicans — don’t care one whit about economically challenged Americans. They see them as a bunch of whiny losers who chose their fate. “Christian” conservatives are a prime example. Republicans have nothing but disdain for ordinary Americans — including the suckers in the MAGA base.
I will never forget how Mr. “Compassionate Conservative” George W Bush refused to make an effort to inform poor parents of their children’s eligibility for that program because he wanted to run on fiscal responsibility and the more kids enrolled the more Texas’s share of the cost would rise. Most of the media played along with his pretense of caring about the poor and the deficit. The late, great Molly Ivins was one of the few who called him out. She also pointed out that NJ’s Republican governor Christi Todd Whitman had mounted an aggressive campaign to ensure parents were made aware of that program.
These rightwing cranks are impervious to evidence. They’re simply mean-spirited.