Editore"s Note
Tilting at Windmills

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September 2, 2009

REFORM, IRONY, AND SELF-INTEREST.... A couple of weeks ago, Sam Stein noted the states with the highest rates of uninsured people, which just so happen to be the states where opposition to reform is strongest. Gallup found "large swaths of populations in the South and West" with large segments lacking coverage, and these are the same parts of the country with "the largest percentage of populations who believe widely perpetuated mistruths about the Obama agenda."

In other words, those in states that stand to benefit most from reform have been convinced to oppose reform. The LA Times had a related story today.

Some of the most vociferous opposition to the proposals before the House and Senate comes from residents of rural states that could benefit most if the present system is revamped.

"The states that tend to be more conservative have a higher rate of people who are uninsured," said Ron Pollack, executive director of FamiliesUSA, which backs a healthcare overhaul. "As a result, healthcare reform is going to provide a disproportionate amount of resources to those states."

In Wyoming, for example, nearly 1 in 3 people younger than 65 went without health insurance at some point during the last two years, according to Pollack's group. A huge majority of the uninsured have jobs, but work for employers who don't provide coverage.

The problem pervades other rural states as well, where a high percentage of employers are small businesses. Although there is a consensus in Congress for keeping the current employer-based system of medical insurance, that system is riddled with holes in coverage that disproportionately affect rural states.

In addition, both in the West and South, such states tend to set higher thresholds for Medicaid eligibility, leaving few options for low-income earners who can't afford individual insurance coverage.

Moreover, residents of rural states often have lower incomes than those in other parts of the country. It's more difficult to find healthcare providers. And they have little, if any, choice in the private insurance market, which is typically dominated by one or two companies in a region.

And yet, lawmakers from the South and West are not only the most likely to oppose reform, they're also the most likely to have hosted raucous town-hall events last month, where organized opposition to reform is strongest.

This, coupled with the polling data, points to a frustrating landscape: "Theoretically, the president should be receiving more support in his efforts to expand coverage from those who currently lack it. The opposite, however, seems to hold true."

Steve Benen 9:25 AM Permalink | Trackbacks | Comments (42)

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What's the matter with Kansas?

Posted by: Miki on September 2, 2009 at 9:27 AM | PERMALINK

It aint irony, but it's iron something...

How do you think these uninsured folks got the mentalities they have about it?

From the state-of-the-art educational systems these states have?

From the vast opportunities to involve themselves in the societal issues and decisions in their state capitols and city halls?

From the diverse views and multi-cultural experiences they have in everyday life?

Heh heh, i guess you wonder how the poor white and the poor black in the south was held down by the aristocratic ol' Massa and Ol' Miss for so long, too, huh? (for that last, try: WJ Cash, "the Mind of the South.")

Posted by: neill on September 2, 2009 at 9:29 AM | PERMALINK

Now you know why it's so important to conservatives to dumb down our educational system. That's how they manufacture GOP voters.

Posted by: Steve LaBonne on September 2, 2009 at 9:34 AM | PERMALINK

Me thinks such resistance by the citizens who would stand to gain greatly speaks to an ever-present, overriding issue our society has yet to come to terms with. Since it is ever-present, and in abundance in the regions borne out in the Gallop study, I also note that health care is perhaps merely being used as a bully-stick! -Kevo

Posted by: kevo on September 2, 2009 at 9:34 AM | PERMALINK

If the government is not going to offer an uninsured person, who could afford high deductible(almost worthless) insurance, something that is better than what is now available, why would that person support being forced to get coverage that they don't want now?

Posted by: Michael7843853 on September 2, 2009 at 9:43 AM | PERMALINK

Yes, these people have once again been persuaded to vote against their own interests, but I would further note that many of them are being driven by a fear not of government takeover of healthcare, but of the notion that undeserving "others" (i.e., blacks, latinos, Chinese, etc.) will get healthcare.

So not so much voting against what benefits them, but voting against what might benefit groups they don't like.

Posted by: Domage on September 2, 2009 at 9:43 AM | PERMALINK

"The states that tend to be more conservative have a higher rate of people who are uninsured," said Ron Pollack...

They're on the Jayzus plan. What could go wrong?

Posted by: doubtful on September 2, 2009 at 9:46 AM | PERMALINK

What's the matter with Alabama? Race and class. Alabama and its politicians are owned and operated by white people with money. White people with money like the healthcare system just as it is.

Posted by: Win Pollard on September 2, 2009 at 9:47 AM | PERMALINK

Probably correlates with educational levels as well. Thus, the polled "confusion" about healthcare legislation.

Posted by: converse on September 2, 2009 at 9:48 AM | PERMALINK

One of the most successful things Republicans do is to convince people in rural areas that the rest of the world is full of evil and amoral people. It's not so different from the abusive father telling his children not to talk to strangers. "You wouldn't want to end up in an orphanage eating gruel every day, would you?"

Posted by: Danp on September 2, 2009 at 9:48 AM | PERMALINK

Drive through many of these places and there are two things to hear on the radio: Rush Limbaugh and Christian talk. It's not that people hate government for a good reason. They hate it because they've been told for decades now that government is giving their money to the wrong people (blacks, Mexicans, furrners) and that you can change this by voting Republican. It's insidious because reason can't beat this. Only some counter-demogoguery, which might at least have the benefit of being roughly true.

Posted by: walt on September 2, 2009 at 9:50 AM | PERMALINK

More evidence that health care is an irrational product whose buyers often act irrationally.

Just another reason why the 'principle of the free market' doesn't apply to health care.

Posted by: grape_crush on September 2, 2009 at 9:53 AM | PERMALINK

I don't think having to buy health insurance will be considered a benefit by these people.

Posted by: Pat on September 2, 2009 at 10:04 AM | PERMALINK

This is yet one more argument for why the Dems should go forward on their own and get a public option passed through reconciliation. The rural and southern voters who are opposed now will turn around once they start seeing health benefits flowing their way. Get it done now so that maybe they can see benefits by Nov 2010.

Posted by: Rosali on September 2, 2009 at 10:05 AM | PERMALINK

The Rethugs have messaging down to a science. When in the hell are the Donkeys going to figure out how to fight fire with fire? If their 'leaders' are frustrated with how a segment that can best be served by HCR is the most vocal opposition, logic would suggest perhaps they isolate a representative pool of these folks, sit them down and discuss the issue. Ask them how they understand HRC. Ask them what they would want to see different. Ask them what concerns them most about their own health. Then run ads in their districts that show how HRC addresses the very issues that concern them most using the exact phrases they use to describe change THEY can believe in. DUH!

Posted by: Chopin on September 2, 2009 at 10:14 AM | PERMALINK

Hey folks, turn that frown upside-down!

We laugh at the folks saying, "Don't let government take my medicare!" But that masks an underlying truth: as conservative as some want to think they are, the liberal entitlements endure.

They know if we give people government healthcare, and they like it, there will be less room for them to manuever. The Republicans see the pinch coming, and know that if Healthcare Reform EVER passes which insures people, they're screwed. The conservative movement will have lost.

All the more reason to pound that stuff through in reconciliation. Ironically, the Public Option, I hear, might have to get more liberal to pass that way! You all should support Democrat's efforts to pass this. It will screw the Right Wing nutballs once and for all.

Posted by: Stephen Daugherty on September 2, 2009 at 10:19 AM | PERMALINK

This is a manifestation of the well-known Stockholm Syndrome - hostages begin to feel sympathy for their captors.

Posted by: Okie on September 2, 2009 at 10:21 AM | PERMALINK

Actually this can work both ways. If we ever pass healthcare reform, the people who are likely to benefit in these places may finally see the error of their ways and reject the GOP.

I was always an optimist.

Posted by: leo on September 2, 2009 at 10:22 AM | PERMALINK

In addition, both in the West and South, such states tend to set higher thresholds for Medicaid eligibility, leaving few options for low-income earners who can't afford individual insurance coverage.

So let me guess: when someone has a medical emergency in these areas they visit a hospital emergency room and that cost is passed on to all of us rubes that actually PAY for health insurance in terms of rising premiums, just so Jimmy John can have the satisfaction of keeping government out of his life.

Then he goes back to his farm where "big government" has been keeping him solvent for decades with free money from ag subsidies.

Posted by: trex on September 2, 2009 at 10:33 AM | PERMALINK

For a certain mentality, there is nothing more insulting than to be helped by a n*gger. It's as simple as that.

It shouldn't be, but it is.

Posted by: Roddy McCorley on September 2, 2009 at 10:38 AM | PERMALINK

Whoa--The logic here has "ecological fallacy" written all over it. Just because hostility to health reform is concentrated in states with high rates of uninsured people doesn't mean that reform opponents are uninsured. The town-hall meetings appear to have been loaded with Medicare folks--whose numbers are also disproportionately high in rural states for demographic reasons. Indeed, the major source of hostility to reform increasingly appears to be hostility on the part of many of the presently insured to paying for those who aren't. Medicare people, in particular, seem to fear that proposals to cut Medicare costs will hurt their health care and be used to pay for health care for "undeserving" types such as "illegals." [And we thought "cost control" would be a bipartisan issue?] In the South, there's an obvious racial and class component to that; large numbers of impoverished people stir enmity among those who aren't. But the South isn't really "rural" any more; the rural states are mainly west of the Mississippi.

Posted by: David in Nashville on September 2, 2009 at 10:40 AM | PERMALINK

This isn't suprising at all. After all, these are the same people clambering for lower taxes for the wealthiest 2% of the population. They're just weird that way.

Posted by: CT on September 2, 2009 at 10:41 AM | PERMALINK

Look at it from the other end of the telescope: if your first allegiance is to conservative politics, and this is your core constituency, then a successful health reform program might do more to explode your base than just about anything else you can think of. None of these townhalls is truly representative of the population of the state in which they occur.

I am convinced that the ferocity of the reaction to Bill Clinton was based on a similar dynamic: if white bubbas could identify with the leader of the Democratic party it was curtains for Republicans. Clinton HAD to be demonized for their own survival.

Posted by: Barbara on September 2, 2009 at 10:42 AM | PERMALINK

Actually this can work both ways. If we ever pass healthcare reform, the people who are likely to benefit in these places may finally see the error of their ways and reject the GOP.

Hahahaha, that's a good one leo. I come from one of these states and the rationality and self interest of rural voters has little to do with their politics. Most are bred into Republican families and by God they'll vote Republican until the day they die. For example, a ballot has candidate 1: a freshly squeezed steamy pile of dog shit (R) or candidate 2: Jesus Christ (D). They'll vote for the one with the (R) every time.

Posted by: tempered optimism on September 2, 2009 at 10:43 AM | PERMALINK

The ability of the Republican nobility to get a large percentage of the public to vote against their best interests is one of their greatest assets.

Posted by: qwerty on September 2, 2009 at 10:47 AM | PERMALINK

Actually, it's quite understandable if the loudmouths in the town halls are the minority that DO have insurance, and don't want "their tax dollars to support deadbeats." Deadbeats meaning anyone less well off than themselves.

Last night at a town hall meeting in Michigan which managed to be reasonably well mannered, one person in attendance stated his opinion that the reform could lead to "socialism" because it would use the money of working people to pay for insurance for those who "won't work." Guess what? He was roundly booed. There are too many people in Michigan who are unemployed and definitely don't want to be to fall for that bogus rhetoric.

Posted by: T-Rex on September 2, 2009 at 10:50 AM | PERMALINK

So basically healtcare reform will be like every other federal program where richer states (that tend to blue, New York California etc) subsidize Federal aid to poorer red states who scream and complain that THEY are paying too much.


Posted by: thorin-1 on September 2, 2009 at 10:52 AM | PERMALINK

There's an irreducible moiety of the electorate who, when confronted with a problem that afflicts only some of us, have as a default solution to make sure that that problem comes to afflict all of us.

It's hard to figure out why the reflex response to "My life sucks, and yours doesn't" is "Let's make your life suck too", and not "What can we do to togther to make my life not-suck?" but it is. It's enough to make one a believer in the inherent depravity of mankind.

Posted by: Davis X. Machina on September 2, 2009 at 11:08 AM | PERMALINK

"So let me guess: when someone has a medical emergency in these areas they visit a hospital emergency room and that cost is passed on to all of us rubes that actually PAY for health insurance in terms of rising premiums, just so Jimmy John can have the satisfaction of keeping government out of his life." No, they pay for this by having the community hold silent auctions, put up tip jars in local restaurants and other businesses for people to put money in, etc. I have been in restaurants in small towns in Kansas and Nebraska and invariably see a plea to help a local family pay the high cost of health care because said family is uninsured and had (a)an accident; (b)a new baby with an organ defect; or (c) cancer or heart problems. These people know the cost of being uninsured, but just can't bring themselves to vote for the party of gays and minorities. It really is as simple as that.

Posted by: Bc on September 2, 2009 at 12:09 PM | PERMALINK

Ah those good-'ole Red states. They're nothing but consistent - dragging down the rest of the Union and bitching about the govt help. I believe the numbers are 1 in 4 Not or under-insured in my "great" state of Texas. Actually may be 1 in 4 NOT insured at all. Yet, Guv Goodhair has been one of the biggest loudmouths, spouting nonsensical states' rights, secessionist talk and how he intends on a state plan NOT a fed plan. Right Perry, where's your plan and how is it better/different from a fed plan?

Posted by: ckelly on September 2, 2009 at 12:22 PM | PERMALINK

I had a conversation with a friend, a breast cancer survivor with no insurance. She opposes Obama's plan or any kind of heealth plan. Its not due to racism but mostly out of a deep libertarian streak and an obsession about debt and how the program will be paid for. Until health care supporters can make the case to self employed conservatives in economic terms they can understand they will not win this argument. Obama has to make his argument in terms of productivity and economics.

Posted by: aline on September 2, 2009 at 12:40 PM | PERMALINK

If these lies and fear tactics successfully kill HCR, I imagine we'll start to see commercials like this:

Scene: Little girl playing with a flower in a field of daisies.

Voiceover: "A sniffle. A cold. A sprained ankle. Everyone gets sick or injured sooner or later.

"But, if your family is insured through Aetna, your sick child will be taken before a panel of "experts" and then put to death.

"The liberal health insurance company Aetna uses the same diabolical health care tactics used by Adolf Hitler and the Nazis. Communists and Al Qaeda, too.

"In fact, Aetna recommends beheading for every ailment from seasonal allergies to erectile dysfunction.

"So tomorrow, when you go to work, march straight into your human resources office and demand that your company switch to good, solid, dependable Christian insurance from Anthem. Start by shouting. Take a gun with you.

"Anthem. Good Christian insurance."

Posted by: chrenson on September 2, 2009 at 12:43 PM | PERMALINK

Well, there's always CheneyCare: take sick people out into the back 40 and shoot them in the face.

Posted by: Hodger on September 2, 2009 at 12:44 PM | PERMALINK

It’s like the health plan protester at the town hall meeting who was carrying a sign showing Obama as Hitler. He got roughed up a bit (I don't support violence, but these clowns need to recognize such a picture constitutes fighting words). After it was all over he had some sprains and bruises and was whining about how tough it was because he didn't have medical coverage.

Posted by: J. Frank Parnell on September 2, 2009 at 2:09 PM | PERMALINK

For example, a ballot has candidate 1: a freshly squeezed steamy pile of dog shit (R) or candidate 2: Jesus Christ (D). They'll vote for the one with the (R) every time.

There are so many inconsistencies with this story and the posts. First, you all assume this person in the article has his facts straight and this is true, based on what? Were his facts verified by the reporter or they are just assumed to be accurate?
Number two: Most who vote Republican are trying to vote for the lesser of two moral evils, and as everyone knows the Dem party hasn't produced a 'moral' candidate in 30 years, so they are 'forced' to vote Rep. That is not to say we don't hold our nose to do it, the Rep. party sticks almost as much as the democrat.
As for the 'poor red states who drag the US down mentality'. Why is that prey tell? Maybe because NAFDA costs us all the jobs here. Oh but in Michigan they have the UNIONS to save their jobs when the car companies can't seem to turn a profit. Yeah, that's fair. NOT. But then, red state voters tend to have these really problematic thing happening called Integrity, and they are willing to sacrifice a lot for it. Maybe they are proud, maybe stupid, but how many inner city voters in the last election could tell the average reporter who the speaker of the house was?? Just look out your own Blue state doorsteps before you cast the stone in our direction, please.

Posted by: independent in the south on September 2, 2009 at 2:44 PM | PERMALINK

One reason people in southern states traditionally have resisted social provision (&, analogously, voting rights laws) is precisely that so many people in their communities would benefit from them. Universal provision would not only upend their positional advantages, it also, they imagine, would cost them a lot. It's easier to be for guaranteed access if you think there aren't many people who need it.

But of course, it's awkward to come out and say you prefer that large numbers of your neighbors go without health care. So people resort to inane made-up reasons to be against reform.

Posted by: K on September 2, 2009 at 3:01 PM | PERMALINK

It's really not ironic at all if you consider how the legacy of first slavery and then racial apartheid still affect the cultural mores of the American South.

Psychologically and culturally, Jim Crow was a deal between a tiny minority of rich whites and the white poor so that the white poor could still feel better than someone else. The poor whites who actually suffered economically from this arrangement (slave and apartheid labor severely depresses the wages of those not discriminated against) were often its strongest supporters.

It's no different today. The tiny minority with a huge amount of money benefit from all the myriad ways that labor is persecuted (starting with the kind of "right to work" laws the Pope castigated in his last encyclical) in the American South. But the working poor go along with it, and that's what is happening now. The whole mythology lets the poor and lower middle class Southerners with health insurance get to feel morally superior to those without health insurance. If the people poorer than them got a leg up, then they wouldn't get the psychological payback that poor Southerners always get in return for economic persecution (compare levels of income disparity in the American South with the rest of the country). Note that universal coverage would clearly result in lower premiums and better care for people lower down in the spectrum that currently have insurance. But that doesn't matter.

There's no irony at all. It's the very same thing that has been going on for over two hundred years in my neck of the woods.

The real tragedy is that since Nixon the Republican party has done everything to make the cultural and economic dysfunctions of the American South universal. Again, there's no surprise here. Every corrupt plutocracy needs this kind of servile, kick-down-kiss-up culture to survive.

Posted by: Jon Cogburn on September 2, 2009 at 3:01 PM | PERMALINK

By the way they also think they won the Civil War; sorry...the "War of Northern Aggression".

Posted by: Jeffrey Davis on September 2, 2009 at 3:13 PM | PERMALINK

There have been various discussions about putting a so-called "trigger" on aspects of health-care reform. I think we should make approval by the states the trigger. Individual states do not pay in and do not get benefits unless the legislatures approve it. I am tired of subsidizing Mississippi and South Carolina already. Let Mark Sanford's constituents keep their crappy health care.

Posted by: JGH on September 2, 2009 at 6:16 PM | PERMALINK

I keep hearing that the public option has an 80% approval rating and everytime there is another obnoxious group of rightwingers at a townhall meeting, I wonder where is that 80%?
I'm originally from the south and I know why southerners aren't there. They are so beaten down and subjugated by a just few in power that they would never step out of their place and actually voice an opinion that is out of step with their neighbors, family and church. It is jarring everytime we go back to see such a large group of people in lockstep with one another. My brother told me that people with views like mine would have to leave the area. I reminded him that I had left the area.
But I don't understand why the rest of the people in this country aren't speaking out. We need that 80% to start showing up at these meetings.

Posted by: dianne on September 2, 2009 at 6:35 PM | PERMALINK

Maybe they are proud, maybe stupid, but how many inner city voters in the last election could tell the average reporter who the speaker of the house was??

Probably more than the trailer trash Republicans here in Texas. And the Country Club Republicans only know it because they LOVE to trash Pelosi.

A West Coast Liberal and a woman to boot. Thats a twofer.

False pride and willfull stupidity.

BTW..I fucking hate independents. Fucking nihlists who love to pat themselves on the back for being "above it all". And then vote Republican every time.


Bernie Sanders excepted. Also

Posted by: SmarkyShark on September 2, 2009 at 9:07 PM | PERMALINK

What JGH said.
Horace Greeley was right ("let our erring sisters go"); the South has been like a millstone around our neck. Time to let 'em all drown so we don't.
To all our comrades down there who'll be hurt -- will it really be that much worse than it is already? At least the rest of the country will be able to run sanely, so you'll have someplace better to which to migrate. But you won't have to change your citizenship. (They'll be the ones to have to change their name -- to "The REAL America," no doubt.)

Posted by: smartalek on September 3, 2009 at 11:00 AM | PERMALINK



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