“Should Mormons use Medicaid?”

Yes.

Should historians write about current events? Maybe not. But when they do, they shouldn’t do it like this.

First, about Medicaid. It’s a great program, especially its expansions through CHIP and the ACA. It assists in the births of around half the babies born in the U.S. My family has benefited from it directly, and it’s opened up some professional opportunities that I wouldn’t have had otherwise. Yay, Medicaid.

Does the church support the use of Medicaid? Yes, it does. As it states in the church’s current welfare manual:

Question: Is it appropriate if an individual is receiving governmental welfare assistance to use Church welfare assistance as well?

Response: Members may choose to use resources in the community, including government resources, to meet their basic needs. The bishop should become familiar with these resources. Resources that are often used include…Hospitals, physicians, or other sources of medical aid.

Now, back to historians. The Washington Post today published a guest column by Allison Kelley, PhD candidate in history at the University of Virginia. In her column, she references the recent—is fiasco too strong a word?—at BYU-Idaho about student insurance and Medicaid. She provides a wealth of interesting information about welfare history in Utah from 1929 to 1945. And she mentions Mitt Romney, cites the welfare manual’s discussion of self-reliance, and notes that the church did not condemn the G.I. Bill or other tax breaks. Kelley concludes, “Though it is not entirely clear why BYU-Idaho removed Medicaid temporarily from its list of ‘acceptable’ health insurance options before relenting, the church’s selective history of maligning certain government-funded programs — while enjoying the spoils of others — offers clues.”

So now let’s mark up that paper.

Speculation isn’t evidence. As Kelley notes, “some have speculated” that church leaders do not want BYU students to be on Medicaid. Further online research will no doubt reveal many additional interesting speculations about church leaders. Mining online speculation is not a good way to generate a thesis.

Don’t pontificate. Kelley asserts that students using Medicaid is “antithetical to the church’s commitment to individual ‘self-reliance.’” It is? Since when? Who said so? Kelley is making an assertion about the concrete interpretation of a particular principle, but that interpretation isn’t self-evident, and Kelley doesn’t offer any evidence for her reading. The discourse of “self-reliance” is complicated and at times highly irritating. It is nevertheless an important concept and its complications need to be understood if using the term is going to be useful; the church teaches civic engagement rather than isolation from society.

Don’t omit relevant evidence (I). BYU-Idaho and the church’s public affairs office both released statements, but Kelley doesn’t mention them. Why cite online speculation but ignore the direct statements of the people you’re writing about? Well, one reason is that the official statements stray from the confines of one’s academic expertise. But ignoring the obvious isn’t going to strengthen an argument.

Now, BYU-Idaho’s response was a case study in how not to conduct public communication, and the decision itself was a case study in how not to conduct institutional governance. But the most likely explanation for anything is usually to give credence to what people say. Does it make sense that the administration would respond to the concerns of the local medical community in a way that overlooked the needs of its students and that left the university holding the bag and dangling in the wind when everything went sideways? Yes, actually, that sounds quite plausible. If the university had actually had concerns about Medicaid, I have no doubt that it would have stated them, loud and clear.

Don’t omit relevant evidence (II). Kelley links to the online welfare manual, but overlooked the question and answer I quoted above. It seems like something that should have been mentioned.

Is your evidence relevant? Kelley offers quite a detailed discussion of events from 1929 to 1945. But 75 years is a long time. A number of things have changed, including in the church and among its membership in a number of relevant ways, in the intervening time. What Mitt Romney, millionaire and Republican presidential candidate, said about Medicare is not relevant to what the church teaches about Medicaid. The sad truth is that events are more contingent than we think, and history is never as relevant as we wish it were, and we can rarely draw a straight unbroken line from the areas of our own expertise to current events. (As much as I wish medieval apocalypticism was a key to understanding the current moment, the Last World Emperor legend also does not actually provide useful insight on evangelical support for Trump.)

The absence of evidence, etc. The church’s failure to condemn “federal tax breaks for corporations or homeowners’ mortgage-interest deductions” is not clearly relevant to anything at all because there are unlimited possible reasons why something was not done. (Also, academics really should avoid treating the G.I. Bill as just another bit of pork for the middle class. A lot of those guys died or came back maimed, and if we funded a college education for the survivors and thus set off the one academic hiring spree we got in the last century, that sounds like a good thing to me.)

Cite your sources. Kelley notes “Church leaders’ insistence that members take care of themselves ‘without help from the government of the United States.’” It seems relevant to know who said this and when, but she doesn’t provide a source and I can’t find one online. I know it’s an opinion column, but some context would be helpful here. Does anyone know the source?

Are you using historical insight to promote understanding, or detract from it? Kelley’s conclusion is that the mystery of BYU-Idaho’s decision is illuminated by the “church’s selective history of maligning certain government-funded programs.” The implication is that the church is hypocritical when it comes to self-reliance and government largesse, preaching one thing to the poor and another to the middle class. And these are interesting topics to discuss! But BYU-Idaho’s decision is only unclear if you take online speculation as more reliable than the official statements of the people you’re writing about. Kelley’s column does not use history to add nuance or context to the present moment. Do PhD students need to publish, engage with the public, and show how the discipline of history is relevant? Yes, absolutely. But you can do better than this.

26 comments for ““Should Mormons use Medicaid?”

  1. ji
    January 3, 2020 at 3:59 pm

    ”BYU-Idaho’s response was a case study in how not to conduct public communication, and the decision itself was a case study in how not to conduct institutional governance.”

    I agree.

    I think it is error to assume that the decision was made by “the Church,” implying the First Presidency and so forth. Rather, I think the decision was made by BYU-Idaho officials who are (coincidentally?) Church members. I think it is a sloppy journalism to attribute the decision to “the Church.”

    I think that the BYU-Idaho officials made the decision in an effort to collect more revenues from students through sale of BYU-I health plan subscriptions.

    When the decision became public, the adults in the room (so to speak) overturned it. I do not know if the overturning happened in Rexburg or in Salt Lake City. I do not know if the overturning occurred because someone felt it really was a bad decision from the onset, or because of the media attention. I hope the media attention brought it to the awareness of someone who decided it was a bad decision from the onset.

    BTW, older versions of the handbook did discourage members from seeking Government welfare assistance (I remember seeing it with my own eyes), but that language was changed many years ago.

  2. Owen
    January 3, 2020 at 5:51 pm

    I don’t buy the current propaganda about all non-Fox news being fake news, but I do despair at the judgement and skill level of the journalists and editors of the world. What are they teaching kids in school these days? Also, get off my lawn!

  3. Bryan
    January 3, 2020 at 6:04 pm

    Academics are among the stupidest people in the world.

  4. Rcj
    January 3, 2020 at 6:56 pm

    It would be good if the church & university leaders would tell why they make the decisions they make and not foist them on the members like we are soldiers. The church is aging. The older people (me) expect a bit more. Openness would help everyone decide if they support the decisions and it would eliminate a lot of speculation. A church example was the restriction of baptism of children of same sex couples. When came out there was no why. There was a lot of speculation about it mostly by church members themselves. I remember brother Nelson calling it a revelation. Then shortly after brother Monsons death the policy was revoked, with little rationale but a lot of speculation. If you are going to make a decision you should be ready to back it up. Always be prepared to give a defense to everyone who asks you the reason for the hope that you have. 1Peter3:15.
    Hence it would be good if BYU- Id explained why they made the decision, whether or not it was based on church beliefs, welfare issues, just money, or anything else so there is no room for speculation. Withdrawing from Medicaid was controversial in & out of BYU-Id. It was news, and left the door open. It appeared arbitrary & capricious to me.
    In response to Bryan everyone are among the stupidest people in the world. So don’t “speculate” about academics with out justification.

  5. p
    January 3, 2020 at 8:10 pm

    Well said, Rcj, thank you!

  6. Cameron
    January 3, 2020 at 9:17 pm

    “Members may choose…” Is not an endorsement. Pretty neutral wording there.

  7. January 3, 2020 at 11:25 pm

    Safety nets are there for a reason. Enough from the right-wing crazies. As someone, somewhere has noted, in the first half of the 20th century, the GAs were hardly ardent capitalists. Why BYU-I did what it is did, may never be completely understood. But where was the president of BYU-I when this PR mess occurred? Maybe he was too concerned about his fast-track to apostleship. BYU needs to select women as presidents.

    Bryan is wrong. My father and 2 brothers are (were) academics. And they are (were) hardly “stupid.” In fact, my one brother recently received a Nobel Prize. My father and other brother did important research that has world changing implications. This kind of anti-intellectualism is deeply troubling. It leads to anti-science, anti-vaxxing, disbelief in global warming, anti-evolution, etc. The glory of God is intelligence, not ignorance.

  8. rcf
    January 4, 2020 at 2:43 am

    Obviously academics are not stupid people, but they are often insulated and imperious, and sometimes make decisions that are short-sighted or ill-informed.

  9. rcf
    January 4, 2020 at 2:51 am

    I should have added that the intent of those insulated decision makers within academia is usually benign and rarely mean-spirited. But the results of well-intended decisions can still be very harmful, as we have seen.

  10. p
    January 4, 2020 at 10:36 am

    An example would be useful here, rcf. What are you talking about?

    Bryan’s comment should be moded out. It is utterly useless & offensive.

    “BYU needs to select women as presidents.” Absolutely!

  11. Ivan W.
    January 4, 2020 at 4:23 pm

    This comments thread has gone downhill almost immediately.

    “BYU-Idaho officials made the decision in an effort to collect more revenues from students through sale of BYU-I health plan subscriptions”

    Groundless speculation that assumes the worst. I prefer charity to mean-spirited speculation, which is what that claim is.

    “Academics are among the stupidest people in the world”

    Silly and paints with too broad a brush. Sure, there are stupid academics, but there are smart ones as well (see Jonathan Green, for example. With my PhD, I am – of course – one of the stupid ones, since I am small ‘o’ orthodox as far as the LDS church goes, meaning I have no critical thinking skills according to certain sectors of the internet).

    “Maybe he was too concerned about his fast-track to apostleship.”

    Silly, irrelevant, and commits several logical fallacies at once. If this is what counts for “reasoned” discourse, count me out.

    Now, to my own experience, somewhat related:

    I recall when I was at BYU, the Stake President did the rounds in the wards to chew out any students at all who used any sort of government help (whether it was medicaid to have kids, or just the free immunization shots at the local clinic). He stated over and over again that it is church policy to never, ever under any circumstances to use any sort of government aid. Some people disagreed with him, but he just claimed they were refusing to follow the brethren. Interestingly, all of his GA quotes were from the 1960s and 1970s.

    Well, the next Sunday, the Bishop, in response to several complaints that the Stake President was flat out wrong, got up and said he was going to read the Church Handbook of Instructions in order to show the SP was right. He then began reading the relevant sections, and it became clear the Bishop had not bothered to read the CHI beforehand, because it clearly stated you should seek all possible sources of aid, including government. The Bishop was visibly shocked, but mumbled “well, that’s the official policy, anyway” and changed the subject.

    [On a side note, that SP was one odd dude. I recall a “thriftiness workshop” he and his wife did, and one of their “tips” was to not buy holiday treats for the kids, but just get a 50 cent tube of toothpaste and let the kids suck on that all day, instead of buying expensive treats; in fact, they may be the only gift you need to get them After all, kids love the taste of toothpaste!]

  12. Ivan W.
    January 4, 2020 at 4:27 pm

    (although I did hesitate to share the experience, as I am somewhat concerned commentators like p, ji, and rogerdhansen above will use it to attack the church. I have known plenty of church leaders who had odd ideas, bad judgment, and bizarre leadership who were still, for one reason or another, an inspired pick. I am quite sure that SP did a lot of good work in other areas. He just had a hobby horse he needed to drop; most of us do, though).

  13. ji
    January 4, 2020 at 4:50 pm

    Ivan,

    I am dismayed by your hostility and uncharitableness. I have never attacked the church in any posting at T&S, ever, for many years. I am also dismayed by your lack of accuracy in quoting me. If you do quote me, you should do so honestly (and charitably).

    I made no definitive assertion as to the reason for the BYU-I decision, but I provided an opinion and clearly identified it as a personal opinion. And it wasn’t a groundless opinion — the contemporaneous facts show that BYU-I really needs more health plan subscriptions to support the student health center, and the contemporaneous facts show that the decision was accompanied immediately by a push to sell health plan subscriptions to those affected Medicaid students. So I am likely right or close to right in my opinion. But what’s so bad about my opinion? It doesn’t cast any disrepute on the decision-maker.

    Isn’t it possible for me to disagree with a decision made by a BYU-Idaho official without disagreeing with “the Church”? But you know what? I’m not the only person who thought it was a bad decision — someone, either higher up at BYU-I in Rexburg or at “the Church” in Salt Lake City, also disagreed with the decision and overturned it — so me and that high-ranking official are in agreement. Maybe I’m closer to right than you are willing to admit.

    Thanks for you story — it shows that lower-level church officials can get it wrong sometimes. But we charitably get along, right? I don’t hate the errant BYU-I decision-making official or your errant stake president, but you seem to hate me. Perhaps your comment was made in haste.

  14. January 4, 2020 at 7:07 pm

    Ivan, I think wondering why the Prez of BYU-I wasn’t visible during the Medicaid controversy is a fair question. Speculating on a possible reason seems reasonable. “Maybe he was too concerned about his fast-track to apostleship.” And the Prez of BYU-I has been a stepping stone to apostleship.

    Your statement “I have known plenty of church leaders who had odd ideas, bad judgment, and bizarre leadership who were still, for one reason or another, an inspired pick.” And there have been others who were not “inspired picks,” What’s your point? The Church has made all kinds of leadership mistakes. Claiming otherwise doesn’t bare scrutiny.

    It would be interesting for BYU-I to come clean on the Medicaid debacle and explain how it happened. Otherwise the Church is destine to continue making the same missteps.

  15. DavidH
    January 4, 2020 at 8:04 pm

    Regarding the history of Church leader attitudes.

    While I was a student at BYU in Provo in 1977, President Ezra Taft Benson (president of the 12) gave a devotional condemning government transfer programs (he included Medicaid and Medicare among them). For some reason, I thought he condemned students taking Medicaid, but I do not see that in the on-line version of the talk. But I do see his condemnation of students taking food stamps. (There may have been debate on campus after the talk about using Medicaid.)

    As pointed out, this is no longer the position of the Church (and it may not have been the truly official position when he gave the devotional in 1977)–but his talk represents something that has remained in my mind (and maybe in the minds of others of my baby boom generation) from my young adult years.

    President Benson:

    “Recently a letter came to my office, accompanied by an article from your Daily Universe, on the matter of BYU students taking food stamps. The query of the letter was: “What is the attitude of the Church on taking food stamps?” The Church’s view on this is well known. We stand for independence, thrift, and abolition of the dole. This was emphasized in the Saturday morning welfare meeting of general conference. “The aim of the Church is to help the people to help themselves. Work is to be re-enthroned as the ruling principle of the lives of our Church membership” (Heber J. Grant, Conference Report, October 1936, p. 3).

    “When you accept food stamps, you accept an unearned handout that other working people are paying for. You do not earn food stamps or welfare payments. Every individual who accepts an unearned government gratuity is just as morally culpable as the individual who takes a handout from taxpayers’ money to pay his heat, electricity, or rent. There is no difference in principle between them. You did not come to this University to become a welfare recipient. You came here to be a light to the world, a light to society—to save society and to help to save this nation, the Lord’s base of operations in these latter days, to ameliorate man’s social conditions. You are not here to be a parasite or freeloader. The price you pay for “something for nothing” may be more than you can afford. Do not rationalize your acceptance of government gratuities by saying, “I am a contributing taxpayer too.” By doing this you contribute to the problem which is leading this nation to financial insolvency.

    “Society may rationalize immorality, but God cannot condone it. Society sponsors Sabbathbreaking, but the Church counsels otherwise. Society profanes the name of Deity, but Latter-day Saints cannot countenance it. Because society condones a dole, which demoralizes man and weakens his God-given initiative and character, can we?

    “I know what it is, as many of your faculty members do, to work my way through school, taking classes only during winter quarters. If you don’t have the finances to complete your education, drop out a semester and go to work and save. You’ll be a better man or woman for so doing. You will have preserved your self-respect and initiative. Wisdom comes with experience and struggle, not just with going through a university matriculation. I hope you will not be deceived by current philosophies which will rob you of your godly dignity, self-respect, and initiative, those attributes that make a celestial inheritance possible. It is in that interest, and that only, that I have spoken so plainly to you.”

    https://speeches.byu.edu/talks/ezra-taft-benson/vision-hope-youth-zion/

  16. p
    January 4, 2020 at 9:01 pm

    Ivan W, the toothpaste thing may be the most wonderful Mormon story I’ve ever heard – and BTW expecting our leaders to be truthful not to mention sane does not constitute an attack on the Church.

  17. January 4, 2020 at 10:36 pm

    ji, the problem with offering even a personal opinion about what the real reason was is that it carries the unstated assumption that the administration was dishonest about the explanation they eventually offered. They may have issues with public communication, but they are not dishonest. Maybe think this one over; I think I agree with Ivan on this.

    Roger, you too are not merely speculating. You’re attributing base motives to someone you don’t even know. Charitable speculation would involve expressing concern about his health or general welfare. You’re being unkind toward someone else, and giving yourself a pass.

    Bryan, I wouldn’t call academics stupid. Sometimes all that intelligence is tragically wasted, and we certainly have our blind spots, but I’ve never met a stupid academic.

    Rcf, if it’s any comfort to you, academics were probably entirely insulated from the decision-making in this case.

    Ivan, David, others, thanks for helping to flesh out the history.

    P, you know why.

  18. Ben S
    January 4, 2020 at 10:36 pm

    Thanks Jonathan. Good post

  19. ji
    January 5, 2020 at 1:07 am

    Well, there can be a difference between being dishonest and not being entirely candid. I won’t charge anyone with outright dishonesty, and I am happy to let the official reason stand, but everyone knows that saying that the decision was made to protect the protect the private medical practitioners in Rexburg is not entirely candid — after all, didn’t the private medical practitioners in Rexburg unanimously affirm that (1) no one from BYU-I ever contacted them; and (2) they are fully able and willing to handle Medicaid patients? I don’t think anyone, not even the Rexburg medical community, really believes the official reason. But the real reason doesn’t matter inasmuch as the decision has been retracted.

    But your key point is valid: ”BYU-Idaho’s response was a case study in how not to conduct public communication, and the decision itself was a case study in how not to conduct institutional governance.”. The decision really was a bad one, and someone corrected it after a hullabaloo was properly raised. The students who raised their concerns when they faced expulsion (or denial of continued enrollment) if they didn’t buy the BYU-I health plan subscription (or obtain other private insurance) were not disloyal to “the Church.”

    Even so, I am not attacking or disagreeing with “the Church” — indeed, I am agreeing with “the Church” inasmuch as it was probably “the Church” that made the call to retract the decision. If the parking department at a BYU campus makes an administrative decision that negatively impacts someone, he or she can disagree with the parking department official’s decision (a member of the Church, no doubt) without disagreeing with “the Church.” Right?

  20. ji
    January 5, 2020 at 1:36 am

    Upon reflection, let me say it differently — to protect the medical practitioners in Rexburg might really have been the reason for the BYU-I official’s decision, and I’ll accept it as such. It was the real reason for the decision. But as we all learned after-the-fact, it really wasn’t a good reason as the medical practitioners in Rexburg affirmed they had the capacity and willingness to handle Medicaid patients. The BYU-I announcement of the retraction included: “The well-being of our students and their families is very important to us. We are grateful for the feedback we have received from our campus community and for the input of the local medical community. We apologize for the turmoil caused by our earlier decision.”

    I believe the apology was sincere. And, I hope BYU-I officials will try to get input from their campus community and the local Rexburg community before future decisions are announced, rather than afterwards as in this case — that’s the positive lesson from the episode.

  21. Chadwick
    January 5, 2020 at 8:56 pm

    I don’t buy the whole “we are concerned about the Rexburg medical community” argument. If demand increases, then these practitioners can expand and recruit. Why in the world is BYU-I trying to play the economics game? I can just imagine executive assistants cold-calling doctors in Rexburg asking them how busy they are. Please.

    The simple fact remains that more transparency would clear the whole thing up. Speculators gotta speculate, unless you give them no reason to.

  22. sute
    January 7, 2020 at 4:05 pm

    “Why in the world is BYU-I trying to play the economics game?”

    I keep mulling over this sentence and I’m not sure whether to laugh or cry. Aren’t the doctors paid? Is the university and hospital dependent on resources? Are there supplies, services, customers, scarcity of resources, time, training, and personnel involved?

    Is acknowledging of that a “game”? Playing economics?

    BYU might not be a business designed to generate a financial profit for shareholders, but it certainly can’t ignore economic reality– even if that means angering some smart people who always know best on the internets.

  23. ji
    January 7, 2020 at 7:22 pm

    BYU-I wasn’t playing its own economics game — that would be fine if it were. Rather, by its own admission, and taking its official reason at face value, BYU-I was trying to play the economics game for the private medical practitioners in the Rexburg area, without ever even contacting them.

    Some have suggested that BYU-I was acting at least partly in its own financial interests to increase revenues by selling more of its own health plan subscriptions, but this audience didn’t like that suggestion.

  24. January 8, 2020 at 1:50 pm

    ji, I think that’s a better way of saying things. Also, I don’t think BYU-Idaho stated that it hadn’t talked to the local medical community. The implication was rather that it had (although presumably not to the two people who later did media interviews). Rexburg isn’t huge, but it has a regional hospital and tens of thousands of residents and students, so the medical community is larger than you might think. At the same time, I also can’t guarantee that the input from the medical community didn’t take the form of a conversation between one doctor and one university administrator.

    The suggestion that BYU-Idaho wanted to sell more student insurance policies doesn’t sound plausible to me. That sounds like the kind of thing the university wouldn’t run by itself in the first place, but instead offload to DMBA. It sounds like an ineffective way to raise money for the university (presumably the student fees would be tied up with the insurance program). Or if the student insurance program is losing money, it seems like it would be easier to offload the program to someone else with a bigger risk pool, or close it down altogether and refer students to another provider.

  25. Brandon
    January 8, 2020 at 4:10 pm

    I read the article in detail and your response in detail. You’re right that the article omits some important evidence and doesn’t consider a lot of nuance. It should be rewritten to take into consideration the matters you bring up. Still, as many comments show, and as a more detailed glance at church history would show, the church has a past of some of its leaders telling members to reject government assistance. Generally I think that the final paragraph of the WaPo oped is onto something. I wouldn’t be surprised to find out that a sort of lingering Bircherism and Skousenism is behind the decision of BYU-I, which really is a much more conservative place than other pockets of Mormonism, to scrap Medicaid.

  26. ji
    January 8, 2020 at 6:56 pm

    I’m pretty sure that more than two Rexbug medical practitioners were interviewed in the press, but regardless, BYU-I itself admitted that its decision was made without input from the local medical community — that was part of the reason for its apology — it seems to me that BYU-I wouldn’t have had to apologize for that if it had obtained such input. The Rexburg medical practitioners who spoke to the press were probably Latter-day Saints, so I will presume they are honest.

    “The suggestion that BYU-Idaho wanted to sell more student insurance policies doesn’t sound plausible to me.”

    Okay, but it does sound plausible to me. Immediately with the announcement was a campaign to sell health plan subscriptions to the affected students. As I understand, these are sold by BYU-I directly to students and do not constitute an insurance product such as DMBA might offer.

    “if the student insurance program is losing money, it seems like it would be easier to offload the program to someone else with a bigger risk pool, or close it down altogether”

    That might be true, but another way to solve such a problem is to sell more subscriptions. I think the need for more income for the health center operations is a real problem that BYU-I is going to have to solve in some other way, because the problem remains.

    The BYU-I officials are human — they can make honest and human mistakes in matters of public communication and institutions governance — I think those were your words, weren’t they? I think it is error to implicitly paint all BYU-I decisions as holy and perfect decisions. Here, I think they made some human mistakes, and then later someone else stepped in to make things right. The correction would not have happened if the mistake had not happened. I am glad for whatever inspiration accompanied the correction, but I do not put any personal blame on an BYU-I individuals — I just disagree with their decision (and so does whoever called for the correction).

    But I’ll stop posting on this thread — I can see that I am offending you by agreeing with your assertion that BYU-I might have made a mistake in matters of public communication and institutions governance. You can have the last word.

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