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October 18, 2012 12:55 PM Not Fully American

By Ed Kilgore

In an absolute must-read—particularly for anyone who hasn’t thought through the implications of the Romney/Ryan Medicaid block grant proposal—Jonathan Cohn of TNR takes a close look at state-level decisions over the health and subsistence needs of poor people. He discovers, as anyone familiar with the subject would strongly suspect, that the poverty-ridden precincts of the Deep South are precisely where state lawmakers are most likely to make life even more miserable for the needy if they get the chance. Indeed, as I’ve noted here on more than one occasion, today’s southern Republican governors and legislators are not only avid to turn down the incredibly good fiscal deal offered to them via the Affordable Care Act, but routinely attack the status quo as far too generous and “socialistic,” and would greet a block grant for Medicaid (or any other “welfare” program) as an opportunity to cut eligibility and benefits to the bone.

Cohn sums up the political and moral implications very clearly:

Restricting access to public assistance and programs obviously isn’t on the same moral plane as denying people the right to vote or holding them as slaves. But these things should weigh on our consciences all the same. Food stamps keep people from going hungry. Unemployment checks prevent people from losing their homes. Health insurance keeps people from suffering and dying. Food, shelter, medicine—these are basic needs to which all people, and certainly all Americans, should be entitled. Over the course of the last century, from the Progressive era through the New Deal and Great Society, the United States slowly but surely moved toward guaranteeing those things. Giving the red states the power to deviate from this course means giving them the right to undo that progress.
Advocates for the red-state approach to government invoke lofty principles: By resisting federal programs and defying federal laws, they say, they are standing up for liberty. These were the same arguments that the original red-staters made in the 1800s, before the Civil War, and in the 1900s, before the Civil Rights movement. Now, as then, the liberty the red states seek is the liberty to let a whole class of citizens suffer. That’s not something the rest of us should tolerate. This country has room for different approaches to policy. It doesn’t have room for different standards of human decency.

The irony has often been noted that many people who profess themselves to be super-patriots violently reject the very idea of common “standards of human decency” for their fellow-citizens, and fall back on “state sovereignty” arguments for resisting them. But I fear what’s really going on is something worse than what Cohn talks about: a deeper desire to immiserate those people who aren’t true Americans wherever they live, beginning with the places where such discrimination is a fine old tradition. We’re already seeing the tendency of national Republicans to treat states like Texas (with its wonderful job-creating devotion to low public services and high corporate subsidies) and South Carolina (with its open, official hostility to the very existence of unions and collective bargaining, in the private as well as public sector) as paradises and models for the whole country.

The Medicaid block grant is probably a way station to the end of publicly supported health insurance for poor people, since once it’s implemented we’ll begin quickly to hear how Dixie is using its “flexibility” to maximize its business-cost advantage over those decadent “liberal” states. Soon conservatives may celebrate the whole country’s enhanced ability to compete with low-wage developing countries. There’s no end to “race to the bottom” thinking—other than the bottom.

Anyone who’s fished into the whole “Moderate Mitt Meme” or who still believes the differences between the liberal and conservative ideologies are insignificant or exaggerated should read Cohn’s piece and ponder it. Are we really one country, and if so, what should it look like?

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

Comments

  • golack on October 18, 2012 1:04 PM:

    Now I'm sure once they hit rock bottom, they'll just break out the dynamite...

  • kevmo on October 18, 2012 1:10 PM:

    It's convenient for the Red Staters to forget two important and related facts: the red states are, in general, the POOREST per capita in the nation. And they are also among the biggest net recipients of federal dollars. This Republican plan is a prescription for further impoverishment, for everyone.

  • martin on October 18, 2012 1:17 PM:

    I think I've posted it here before, but here is the statement from the Governor of AL. Total Republican hogwash. It's grand living in a 3rd world nation.

    MONTGOMERY Due to a lack of proper options and very little guidance from the federal government, Governor Robert Bentley on Monday chose not to confine Alabama to an “essential health benefits” plan under the Affordable Care Act.

    Governor Bentley explained his decision in a letter to Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services.

    “As you are aware, I am a staunch opponent of the Affordable Care Act,” Governor Bentley wrote. “As both a physician and a governor, I have determined that it is irresponsible and short-sighted to make a decision on essential health benefits by confining the decision to a select few plans and without having been offered clear guidance from the federal government.”

    Under the Affordable Care Act, “essential health benefits” were to be established by states as a foundation for medical coverage in the years 2014 and 2015. However, Governor Bentley said the Affordable Care Act does not present options that consumers need in order to control costs and actually receive higher-quality care.

    “I truly believe that in order to control costs, consumers themselves must be a part of any equation. As such, I am a strong supporter of health savings accounts,” Governor Bentley said. “Health savings accounts empower the consumer in all aspects of health care decision making. The Affordable Care Act includes many provisions, all supposedly geared toward making health insurance affordable, yet it does not include any significant mention of health savings accounts. I contend that the law does not make health insurance affordable and negatively affects consumer choice.”

    “Health savings accounts provide what the ACA does not: a consumer-oriented, marketplace-driven option for health coverage,” Governor Bentley added.

    Without such an option, and without further information from the federal government, Governor Bentley said it would be irresponsible for him to commit Alabama to a specific benefits plan.

    “The parameters placed on the selection of the essential health benefits benchmark plan do not allow states to select innovative mechanisms, such as health savings accounts, or a variation thereof,” Governor Bentley said. “As such, I decline to make a decision on the essential health benefits benchmark plan. There is simply not enough valid information available now to make an informed choice for such an important decision.”

  • citizen_pain on October 18, 2012 1:19 PM:

    I would think that if the neo-confederate states implement such measures, there would be quite a large exodus out of those states by the people affected.
    Which would be a good thing in my mind. Most blue states provide welfare to the neo-confederate states for the poor anyway, so this way we would eliminate the waste, fraud, and misuse of this money.
    Then the great people of the neo-confederate states would have all the liberty and freedom they can handle, free from the burden of lazy blacks and immigrants, to compete with Chinese and Asian/Pacific slave laborers.
    Yes, Bubba can now pick his own cotton and lettuce, not some black or latino. Freedom! God Bless the USA.

  • c u n d gulag on October 18, 2012 1:21 PM:

    No, we are no longer one country.
    And we haven't been in awhile.

    Somehow or other, for about 125 years, the Union held together.
    But now, the Old Confederacy feels, and is becoming, ascendant.
    The Civil Rights Acts began the unraveling, and the influx of Hispanic immigrants has accelerated that.

    I have no solution for this, short of a split.

    We can either have a Cold Civil War, where the two sides slowly work to maintain the peace, as people move from one area to another - NO Southern Berlin Walls, in other words.

    Or, we can wait, and keep working to prevent a Hot Civil War - with open insurrection a possibility at any time.

    And this may happen THIS YEAR!

    All that may be needed to set of a string of violent incidents, will be an Obama win in the Electoral College, while Mitt wins the popular vote.

    Growing violence may necessitate the direct intervention in certain cities and states, of the Federal Government, via National Guard troops, or even US Army, Navy, Air Force, and Marines.
    And I can see this further inflaming the racists and xenophobes, who will escalate the violence.

    Maybe you think I'm nuts, and FSM I've given the other commenters here plenty of reason to think so - but I think this is a reality.
    And if not this year, then certainly in the near future.

    If Mitt wins, the North won't want to secede.
    If Obama wins, the South may/will.

    And even if Mitt wins, and there's no active Civil War, any victory in the future by a Democratic President, may/will set-off the fatal spark.

    Conservatives will not be happy until they rule - and they won't care if what's left to rule is a smoking ruin, littered with corpses.
    That, may actually, make them happier.

  • AMS on October 18, 2012 1:37 PM:

    I have long been struck by the Republicans' open avowal of their intention to see that people who aren't in their camp get what's coming to them. This is perfectly encapsulated by Mitt Romney's infamous 47% video. His backpedaling notwithstanding, it's pretty clear that no Republican sees him or herself as President of all the people. Obama does---even though some of the people will never accept him as such.

    Also: what do Republicans think will happen to civil order if millions of people are without access to basic necessities like food, shelter and health care? I think it's obvious: desperate people do desperate things to survive. We will devolve into a police state in which the government's main function is protecting the small number of haves from hordes of have-nots. Good bye, civil liberties, good bye, American democracy. Ben Franklin's "A republic, madam, if you can keep it" will become our national epitaph.

  • DisgustedWithItAll on October 18, 2012 1:42 PM:

    Again, if somebody couldn't see what is going on, after the last 20+ years, and especially the last 4, then that somebody is a fucking idiot. It's hardly worth spending words on anymore because if the evidence wasn't strong enough already for someone, it's never going to be strong enough.

    The shit is doing down right in front of your very eyes.

  • Peter C on October 18, 2012 2:01 PM:

    I think 'secession' is still a hard sell in much of the South, @CUND. I moved to Texas in 2010, and soon I'll be a property owner. But I moved here for a job, not for political reasons. I see bumper stickers that are colored like a Texas flag that say 'Seceed!'. But I like being an American, and when framed as 'Why do you want to take away my US Citizenship?', I think secession will run up against a powerful negative visceral reaction.

    Texas has seen a massive population growth, but it is not all from a higher birth rate or migration for ideological reasons. I think much/most of the growth is due to migration of Americans.

    In the 1800s, people did not move out of their states very often, but I'm almost 50, and I've lived in 5 states so far.

  • danimal on October 18, 2012 2:12 PM:

    Every election is THE MOST IMPORTANT EVER, but this one may be. If Romney wins, he will move to pass the Ryan Budget expeditiously. The demoralized Dems won't be able stop it, especially if there is a GOP majority in the Senate. But there are enough Manchins in the Senate that the GOP could pass its agenda with a minority plus a few defectors.

    The block-granting of the social safety net would ensure the decimation of the safety net. The reason is simple, the 'race to the bottom' logic demands it. Also, once food stamps and medical care are viewed as state responsibilities, the federal government will balance its books by reducing the block grants. Ryan's budget is an opener, once the logic is accepted, the funding decrease will only accelerate.

    I'm not completely pessimistic. A few years of devestating cuts may persuade 'moderates' that all the complete BS they have been fed by the GOP isn't an operational success. But the carnage in the interim would be an unnecessary tragedy.

  • Gandalf on October 18, 2012 2:17 PM:

    The great mystery to me is why the people in the south and central states keep voting for those asshats.

  • Mimikatz on October 18, 2012 2:21 PM:

    Obviously this s largely racial, but there are enormous numbers of poor whites in the South. There may be some relatively enlightened pockets like Atlanta, but not many. But it is harder than many think for poor people to move, and how are the products of substandard Southern schools going to compete, even in places like California? Probably, to the extent these troglodytes think, they are hoping for emigrants from the South to fight with immigrants in other states for scarce jobs. Or. They think prisons can warehouse them.

    These Southern "leaders", most of whom profess to be Christians, are truly despicable people.

  • c u n d gulag on October 18, 2012 2:26 PM:

    Gandalf,
    They vote for these asshats, because people are scared - and need someone to hate besides themselves.

    And so, the politicians down in red areas 'divide and conquor," and use wedge issues:
    "It ain't your fault, White Man!
    It's them Nigrahs/Sp*cs/T*welheads/Ch*nks/Feminazi's/F*gs/Dykes, and them Inj*ns - our own Red ones, an' them D*theads!"

    And that, boys and girls, is how they win.

  • Josef K on October 18, 2012 2:29 PM:

    Okay, here's a thought: the Red States like block grants so damned much, let's make all Federal assistance a single block grant. Medicare, Medicaid, infrastructure, defense contracts, the whole nut is just one huge annual block grant, with the monies doled out directly proportional to the tax contribution of a given state.

    That's right. States get back exactly $1 for every $1 they kick into the general fund. They can spend or not spend or "cost control" however they want. But that's it; no disaster funds, no bailouts, nothing else. They can sink or swim on whatever little they pay out.

    And if they make some really bad industrial decisions and suffer an environmental disaster or three, oh well. The National Guard moves in and closes the borders 'cause, well, Federal assistance stifles innovation and all that. Wouldn't want to give those siftless disaster victims the wrong idea that they shouldn't suffer for their mistakes, right?

    Yes, I realize that's a rather libertarian outlook, not to mention completely unworkable and more than mildly sociopathic. But I'm also quite frankly sick to death of these idiots pretending they're anything more than the ultimate moochers.

  • David Martin on October 18, 2012 2:37 PM:

    As other commenters have noted, even if Obama is re-elected and the Senate remains Democratic and the court-weakenend Affordable Care Act remains in effect, we're facing a future in which the Northeast, the Pacific, and most of the Middle West adopt plans for near-universal health care, while the rest of the country, notably Texas and Florida, rush to cut their Medicaid plans to some bare minimum. In Florida, that might mean continuing to pick up assisted living and nursing home bills for the aged and disabled, but hardly anything more. The state has already stopped accepting federal money for medical care for poor children.

    I suppose that in the future, people who are indigent in terms of health care will migrate north or west.

    I wonder about the consequences of the health care divide for keeping the US a nation. Northern states would seem to have incentives to discourage medical immigrants, while the South could continue to promote its low-wage work force and low taxes.

  • hornblower on October 18, 2012 2:50 PM:

    The other day in Florida I was in a pool. I got into a conversation with two mature women who were convinced that Mr. Obama was a socialist, not American, wants to give all our money to people on welfare, voted present in the Senate on every vote, got striped of his law license, stole his election in Ill. I could go on. Oh, he is demonizing the rich.
    I was really sad and went up to take a shower.

  • David Martin on October 18, 2012 2:53 PM:

    My Florida neighbors have Allen West signs in their yards even though they aren't in the district where he's currently the congressman, nor the new one where he's running.

  • Robb on October 18, 2012 2:54 PM:

    This is all very depressing.

    The South has had its hierarchist Plantation Owner Libertarianism for longer than we've been a nation.

    First it nearly kept us from having a working Constitution (and led to one with ridiculous electoral tweaks that give disproportionate electoral power to sparsely populated regions or regions with high populations of people who can't vote-- first slaves, now prisoners-- thus empowering those who enslave and imprison and intimidate the population).

    Next it led to a Civil War!

    And now... are we seeing something like a Civil Cold War?

    I would have hoped that time and migration would have destroyed the South's bizarre plantation-based political philosophy, but it's come back strong as ever, spread even. And it is incompatible with the relatively egalitarian philosophy of the North.
    And now we have the descendants of Northern Republicanism like Romney full-throatedly endorsing the Southern neo-feudalism.

    It's disconcerting.

  • latts on October 18, 2012 3:03 PM:

    Mimikatz, the system is designed to trap the less advantaged, and it also provides opportunities for a sort of stability in exchange for compliance. Finding a more respectable mentor or publicly accepting Jesus as your personal lord & savior go a long way toward giving poor whites access to somewhat better opportunities in the deep south-- the catch is that they have to basically pledge loyalty to the existing power structures. It really is like a feudal system, or a cult... give up your independence of thought (because look how it's failed you so far) and join the people who can help & support you. And if you prefer to not 'act right,' well, life's cruel.

    The thing that surprised me & my sibs after leaving was the way generally-competent people demurred when we talked about better opportunities elsewhere (still in the south, but in cities); at first, they'd say oh, that sounds great but it costs so much, then after being told the additional expense was usually housing-related & easily covered by better opportunities they'd just kinda trail away with something like 'well, I'm glad for you but I couldn't do it.' We couldn't figure it out for the longest time, but it eventually became clear they didn't want to try to function outside the system, where the potential rewards were higher but so were the standards-- no one cared who your people were or what church you went to, and there was more competition. It makes sense, I guess, that such an unequal culture really lowers the bar for the people at the top, too, so they can be comfortable without having to really strive. It's depressing, yet still contemptible.

  • boatboy_srq on October 18, 2012 3:13 PM:

    @Peter C:

    I have to disagree. Secession is frighteningly possible.

    Texas may still identify as a state first, but there are plenty of Southern states that may not. AL, MS, LA, GA, SC, TN and (believe it or not) FL fall in that camp: dislike/distrust of "Big Gubmint" overrides other considerations - assuming those considerations are even weighed.

    I think the "moderating influence" of incoming residents is a misguided assumption as well. Most of the Teahadists I met in FL were first- or second- generation residents, and most came from the North (places like Michigan, Ohio, Minnesota and Illinois). The ones moving South are bring more hard-core Conservatist thought rather than diluting what's already there. In doing so, they're trampling the more genteel Southern behavior patterns, so what gets broadcast is not only more extreme but also more crass: it's the GWHB v. GWB or Connie Mack III v. Connie Mack IV level of distinction. The intransigence, absolutism and rejection of bipartisanship (as defined by most people) is a recent phenomenon - and as much an artifact of the popular migration as anything else.

    If your neighbors took a second to think through your question, they'd answer that their rights as Americans would be superseded by their rights as Texans (which one assumes they think would be more numerous and more expansive) - but that implies that your neighbors are thinking when they make these decisions.

  • Mitch on October 18, 2012 3:31 PM:

    I've never understood the "State's Rights" mindset. I'm an American, not a Kentuckian (place of birth), Californian (place of residence), Virginian (2nd highest total number of years lived), Illinoisan (father's place of birth) or a "citizen" any of the five other states that I have lived in during my 32 years (Dad was Navy; we got around).

    I am a son of the United Stated of America. I pledge allegiance to the flag of the USA, not KY, CA, VA, etc.

    I view any attempt at dividing the States as somewhat offensive. Yes, I know that things were a bit different during the past. But we do not live in the past. We live in the 21st Century. And I would rather call the United States my home than any of the States in which I have lived.

    That being said, most of the comments above are spot-on. The South is a cesspool of poverty and bitterness. Powerful employers pay next to nothing and mistreat their workers, knowing that there are thousands of other desparate scramblers out there ready to replace any employees that they lose. I left the South ten years ago, and never looked back. The children of those states will continue to leave in search of better opportunity.

    The hubris of Red States never ceases to amaze me. They arrogantly claim that their way is the only way, the American Way, and they insult any deviation from their standard. Yet they are for the most part "race to the bottom" hellholes, and don't seem to realize it. Some Red States are exceptions to this(particularly in the Southwest) but these exceptions do not change the truth that life in most Red States is a miserable experience for the working class.

    How much worse can it get for such people before society as a whole begins to crumble? A desparate population is an unstable one. Humans may often act like sheep, but hunger, poverty and rage can turn any of us into wolves. The saddest part is that all of that rage is usually turned at folks in other regions, or of different ethnicity/heritage/religion. Not at the cynical "leadership" that profit from keeping the working class poor and helpless.

  • Mitch on October 18, 2012 3:46 PM:

    @latts

    "The thing that surprised me & my sibs after leaving was the way generally-competent people demurred when we talked about better opportunities elsewhere ..."

    I know exactly what you mean. I hear these kind of statements often from friends/family in the South. They create a million excuses to avoid leaving, and to try and convince me to stay or return.

    There's a term for this kind of behavior. Our friends and family in places like that are Institutionalized.

    I genuinely pity those who live in fear as deeply as many of my loved ones in the South. And I worry, because their intense fear of other places/other ways of life can easily be (and often is) translated to hate.

  • latts on October 18, 2012 4:11 PM:

    @Mitch: Luckily, no one tried to convince any of us to stay-- they knew we didn't belong there. I guess enough drunks in one family's history will make even the most boneheaded people admit that their culture ain't for everyone ;) A few relatives on the more teabagger side of the family mutter about us being snobs, I guess, but it's not like we miss them or anything.

    But leaving is scary, and expensive when it's hard enough to get ahead. College got two of us out, and one had to lose his job & house before taking a friend's offer of housing in a larger city (he now earns more than the rest of us, btw). Sponsorship helps when relocating, but not everyone has that option. It is kinda like being a refugee; you honestly don't know if you can measure up in a faster-paced environment, and the fact that you really aren't prepared is a built-in stumbling block. It's awful, but I've always gotten the sense that people back home are pleased when someone who left comes back wounded, so they can 'welcome' them and congratulate themselves as well. Even at its best, which is to say its 'nicest,' the culture's really loaded with traps and obstacles to keep people in.

  • DisgustedWithItAll on October 18, 2012 4:54 PM:

    I almost don't have to think about it anymore. I no longer want to live in the same country as James Inhofe. Let them go. I don't even care if they take the name. It's nearly ruined anyway.

    I'm tired of the assholes. I'm tired of listening to the full-on stupidity. It's difficult for me to believe there are people who believe the dinosaurs roamed 6000 years ago are on the science committee in Congress.

  • Mitch on October 18, 2012 5:42 PM:

    @latts

    Oh, not everyone wants me to return to Appalachia. One of my uncles told me (at the Christmas dinner table), "People who live in California should stay in California. Leave America for the rest of us."

    You are speaking a lot of truth. Such as, "people back home are pleased when someone who left comes back wounded," that is a pure fact. I recall speaking with an ex-girlfriend right before I left the South and she said, "You'll be back. You won't be able to make it out there." She was very wrong. Not only have I "made it", I have been rather successful. Old friends are always astonished that I remain in CA, that I love it here, speak highly of this area and have built a decent life for myself.

    It WAS hard, and it was a gamble. My college education has nothing to do with my occupation, but I am an exception to the rule. I built a career for myself through hard work, brain power and the help of a boss who had faith in me.

    I haven't needed government assistance at all during my adult years, but unlike the "genteel" folk of the South, I don't mind that my tax dollars go towards those who do need help. I view it as a patriotic and neighborly duty—we all should pitch in to help those who need it. Life's too short and painful as is; we should strive to make it better for us all, for no other reason than respect and empathy for our fellow people.

    Finally, your last statement is brilliant, "Even at its best, which is to say its 'nicest,' the culture's really loaded with traps and obstacles to keep people in."

    As a child of the South, I have to say that 'Southern Hospitality" is a mask. The sweetest old ladies in the South will sweet-talk you all day long, then eviscerate you behind your back. They really are not any kinder down there than in any other small-town environment; they just hide their scorn behind a smile and terms of endearment.

    I feel that entire part of America has been poisoned. Poisoned by their theocratic habits, by their sense of superiority, by their immense fear of The Other. Every day I hope that this toxic hubris fades away, or at least doesn't spread any further.

  • latts on October 18, 2012 6:08 PM:

    @Mitch

    Oh, I love it when the old Confederacy is transformed into 'real America'... and places like Massachusetts that birthed the freakin' country are mocked. It's crazyland! People still aspire to most of blue America, while the red parts are at best the scaled-down model.

    I think the hypocrisy of the culture is mostly a kind of projection-- the niceness is personal and very, very conditional, while the hostility & resentment are pushed out into the larger world of politics and cloaked in some kind of twisted sense of principle. They really don't think that the nastiness of their policy preferences has anything at all to do with their character, except in a positive sense of displaying strength (we all know that's fake too, but the cognitive dissonance is strong). That I don't think people with their worldview are especially good people tends to shock them, which I enjoy a lot, but it doesn't convince anyone of my positions either.

  • Rose on October 18, 2012 6:27 PM:

    Great blog post, great comments. A little depressing, but there are thoughful people in these "United States".

    Thank you all!

  • Sean Scallon on October 18, 2012 7:12 PM:

    "This country has room for different approaches to policy. It doesn’t have room for different standards of human decency."

    Channeling the spirit of William Lloyd Garrison and John Brown I see? Well before you Yankee Puritans go burn Georgia to the ground again (and poor Ed's home) I would remind you that this is not a sectional issue, since you'll find Republicans from Maine to Wisconsin to California who feel the same as those in Texas and South Carolina do (maybe they don't read Ayn Rand like Congressman Ryan does but it's the same general philosphy.) Perhaps a better strategy than refighting the War Between the States is to convince the majority voters of Georgia and Mississippi and Alabama (who, after all, did vote for the New Deal I would remind you) to support such programs for the poor rather than opposing them. Maybe one day you'll get a solid electoral majority instead of 50 percent plus one