On health care, cruelty is the point
The delta variant of the coronavirus is spreading rapidly, we are told, and vaccination rates are low here. Seven of the 10 states with the lowest rates of vaccination are in the Deep South, including Alabama, Mississippi, Georgia and South Carolina. That means residents of the region will continue to get sick and die from COVID -19 in higher numbers than those in other parts of the country.
There are many reasons for the low vaccination rates — poverty, low educational achievement and science-denying Trumpism among them. But a dismal system of health care is at the center of the problem.
While the U.S. Supreme Court recently rebuffed another attempt to kill the Affordable Care Act, a ruling that ought to be a signal to opponents that Obamacare is here to stay, the decision couldn’t force Republicans at the state level to expand Medicaid. Twelve states — most of them, again, in the Deep South — have refused to expand Medicaid, leaving some of their poorest residents without health care.
The vaccination is provided for free by public health clinics and pharmacies, but many poor people don’t know where to go to get it. Many more are reluctant to get it because they have been swayed by the conspiracy-mongers who insist that the shots cause harm. However, those skeptics might be persuaded to get a vaccine if they had a comfortable relationship with a physician. Most poor people without health insurance don’t have that.
Since Obamacare passed in 2010, I have watched in anger and frustration the repeated Republican attempts to either kill or cripple the program. I have watched with dismay as GOP governors and Gop-dominated state legislatures refused to pass the Medicaid expansion facilitated by the law.
Though Medicaid is jointly funded by states and the federal government, the Affordable Care Act mandated that the federal government would pay most of the cost of expansion. President Joe Biden sweetened the deal. In most states, the very poorest women and children are already covered by Medicaid; the expansion would now cover the working poor, including men without children in their households.
As The New York Times’ Sarah Kliff notes, several studies have shown that Medicaid has saved lives in the states
that have expanded coverage. She pointed to a recent study showing that “people 55 to 64 living in states that chose to expand Medicaid coverage were less likely to die in the four years after expansion than people with similar demographic characteristics in states that did not expand.”
Yet Republicans have gone to great lengths to block Medicaid expansion. Residents of six states will gain coverage because they passed ballot initiatives to bypass governors or legislatures that refused the Medicaid expansion. But in Missouri, where voters passed an initiative to expand Medicaid, the state’s GOP leaders nevertheless refused. A state judge recently backed the GOP leaders.
This is simply heartlessness, a desire by conservatives to keep poor people under their bootheels. Some Republican politicians have trotted out the same excuse they use to oppose generous unemployment benefits: that lazy people won’t work if they are given health care. This is madness. Sick people can’t work. If Republicans wanted an economy that functioned better, they would make sure that all their citizens could get treated for diabetes, hypertension and heart disease in addition to injuries from accidents.
It has become clear that a foundational pillar of the conservative movement is sorting people and deciding who is worthy and who isn’t. If you are poor, they believe, it’s your own fault. If you are rich, it’s because you worked hard and earned it — the many wealthy heirs who are members of the Lucky Sperm Club notwithstanding. (That group would include Donald Trump.)
Adam Serwer put it more bluntly in his 2018 essay, now part of a collection in a new book, “The Cruelty is the Point: The Past, Present and Future of Trump’s America.” Writing in The Atlantic, he said, “It is ... cruelty, and the delight it brings them, that binds (Trump’s) most ardent supporters to him, in shared scorn for those they hate and fear: immigrants, Black voters, feminists, and treasonous white men who empathize with any of those who would steal their birthright.”
Cruelty is the only reason Republicans would oppose an expansion of Medicaid.