Welfare in the Real World: Does It Really Help Children?

By Rodney N. Kreider, M.D. F.A.A.P.

Recently, the Georgia Public Policy Foundation asked its members for examples of how government has affected their lives. The following article is one of the many responses we received.

I’m a board-certified pediatrician who has been associated with one of metropolitan Atlanta’s oldest and largest pediatric practices for the last thirteen years. Our practice has a fairly typical and diverse patient population.

I do not represent any group or special interest other than children, nor am I a professional spokesman for any group or cause. I am simply a pediatrician who would like to share my daily experiences because I care about children and their families.

I believe that any meaningful discussion of welfare reform has to include the Medicaid and Women, Infants and Children (WIC) programs. When I hear politicians and bureaucrats bragging about these programs, I wonder if they live in a far different world than the one I see every day. While these programs sound wonderful on paper (health care and nutrition for pregnant women and children, respectively), in the real world these entitlement programs are generally a disaster because they subsidize, and therefore encourage, teenage pregnancy and illegitimacy. When the Medicaid and WIC programs are combined with other programs such as Aid to Families with Dependent Children (AFDC) and housing subsidies, they create an “entitlement package” to have babies that cannot be properly provided for.

Some people maintain that cutting these programs would “punish” children. I do not wish to punish children — I love children — that’s why I became a pediatrician. But the way Medicaid and WIC are structured punishes children, their families and their communities. Stacks of studies have documented the linkage between single-parent households and a host of social pathologies such as juvenile crime, educational dropouts and failures, drug usage, emotional and developmental difficulties, and future generational welfare dependency. Thirty-three percent of all American infants are now born out of wedlock, and the rate is around seventy percent in the African-American community.

I have witnessed the number of Medicaid recipients increase dramatically over the last few years. I would estimate that seventy percent of the children I see under Medicaid are illegitimate — some of my colleagues estimate as high as eighty percent. While many of the parents are teenagers, many are in their twenties and thirties with fathers who have good jobs, but who choose to remain unmarried in order to qualify for these programs.

Another problem is that many of these parents don’t even take advantage of the services that are provided. Some of the mothers decide to forego prenatal care despite its free availability, a contributing factor in premature births and infant mortality. Other common behavioral problems include routinely failing to show up for well baby care appointments, and failing to get child immunizations despite free treatment and transportation. Ironically, iron-deficiency anemia is most common in WIC and Medicaid participants even though everything needed to correct this condition is provided free. And although our practice is open 365 days a year and we are available 24 hours a day, I have been unable to persuade many mothers from taking their children to hospital emergency rooms for minor illnesses, thereby running up enormous tabs at taxpayer expense.

Medicaid is a big business. Georgia spent almost $3 billion on it last year alone, and it is the largest and the fastest growing of all state programs. Sixty percent of newborns and forty percent of preschool children were covered by Medicaid last year. This insatiable demand for “free” medical care drives up health care costs by forcing providers to shift costs to other patients and through the over-utilization of medical services, especially hospital emergency rooms.

While I believe Medicaid helps some truly needy individuals, these persons are a small percentage of the ones we see. Tragically, because of the rampant waste and abuse of the Medicaid system, deserving people often don’t receive the help they need, a point not often brought out in the media. Many parents of children with chronic, severe medical problems have tearfully told me that case workers suggested that they get divorced and live together in order to qualify for aid. There is something really sick about all of this.

I’m not advocating denying health care to children and pregnant women. Charity care has always been available, and much less charity will be necessary if we stop subsidizing these destructive behaviors. In thirty-nine years, our practice has not turned away a single sick child due to inability to pay. I myself came from a modest background. I worked my way through college and medical school, so I know what it’s like to struggle. But these programs are not about poor people or sick children — they are entitlements to have babies. Many parents work two and three jobs to make ends meet and make responsible decisions. When they find their taxes going up to pay for others, they are justifiably angry.

What can we do? I don’t have all the answers, but I would suggest that we re-examine the effects these programs have on children and families in the real world. Reforms should be based on an objective look at our experiences over the last thirty years. For example, Medicaid might be restructured to help children with chronic, severe medical problems or as temporary aid when breadwinners lose their jobs. In order to help parents provide health care for their children, we could pass insurance reforms such as portability, exclusion of pre-existing conditions, and expansion of well child care coverage. Medical savings accounts are also worthy of consideration.

First and foremost, we must emphasize individual and parental responsibility. Fathers must be identified on birth certificates and be required to provide child support, including health insurance. People should be encouraged to get married before having children and to finish their educations. We should strongly promote sexual abstinence for unmarried teenagers, and parents should be educated about the importance of preventive health care and immunizations.

Finally, we should allow family members and resources such as fathers, grandparents, extended families, churches, charities, local community organizations, and schools to regain their influence over our children that the federal government and the media have undermined. As President Clinton has said, “Government doesn’t raise children, parents raise children.” This is more than just political rhetoric; it reflects the common sense that served our society well for many years and which should guide our deliberations as we consider true welfare reform.

Dr. Rodney N. Kreider is a member of the Georgia Public Policy Foundation. The Georgia Public Policy Foundation is an independent, nonpartisan organization dedicated to keeping all Georgians informed about their government and to providing practical ideas on key public policy issues. The Foundation believes in and actively supports private enterprise, limited government and personal responsibility.

Nothing written here is to be construed as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature. © Georgia Public Policy Foundation (April 1995). Permission is hereby given to reprint this article, with appropriate credit given.