We already know that the “One, Big Beautiful Bill” is supposed to get lazy people off their couches and go out and a get a job in order to receive Medicaid. Even though three quarters of the current recipients are either already working, disabled, or too young or too old to work. Ok you say. So, the rest of them will just have to suck it up.

But the reality is, these new work requirements are not really intended to create a new generation of Horatio Algers pulling themselves up out of poverty. What they’re really intended to do is keep really needy people off the program by putting new barriers in their way. Things like asking people who can’t afford internet access to upload documents to websites that crash all too often. Making people who are actually terminally ill and perhaps suffering from dementia record the number of hours they volunteered at the hospice where they reside. All of that sounds bad enough. But it really is just an extension of the Eligibility Industrial Complex that today sucks up nearly as much money trying to prevent people from accessing health care as it does in delivering care.

Unless you’ve spent endless hours in bureaucratic mumbo jumbo the way I have (I was a Medicaid director in a state for 25 years), you probably have no idea how much the states and the federal government pay to huge tech firms and consultants to make poor people demonstrate why they should receive benefits. It’s a gold mine for the wealthy and a deterrent for people to ask for help. This has been happening ever since Medicaid and Medicare were established in 1965.

While Republicans constantly are harping about how regulations and paperwork tie up businesses in the private sector, they love imposing even greater burdens on clients who have the temerity to ask for cancer treatments or perhaps help with the delivery of a baby. Do they really think that people put themselves through the paperwork version of the old mill just for fun?

Take the colonoscopy, for example. Doctors say that those of us of a certain age need to repeat this procedure every 5 to 10 years, although they don’t say how we’re supposed to pay for it. Does the government think people enjoy drinking that gunk and pooping at all hours of the night only to wake up starving and to be heavily sedated while they stick a probe in you? Do they think people would fake their way onto Medicaid so they could enjoy that experience?

People have legitimate reasons to seek health care because whether they’re rich or poor, insured, or uninsured, they still get sick. The pandemic should have taught us that. Sure, there is plenty of fraud in all health care programs, whether public or private. But the biggest cash recipients of that fraud are not mothers sharing a Medicaid card for pregnancy tests, but providers who scam the claims systems for billions of dollars. Someday someone will actually calculate the cost of preventing people from being eligible versus the costs of simply providing health care to everyone who needs it. I’ll be interested to see what that shows.

David Parrella lives in Buckland.