When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?


White People Power

nyt-southern-fold-600x365New Orleans    Reading the papers this morning, I could see the future, and it was very scary!

The New York Times was speculating in the wake of the Republicans beat down of the Democrats in the midterm elections about where the Republicans might find a path to victory at the presidential level that has seemed to increasingly elude them with the changing demographics of the United States. Not to put too fine a point on it, but surprising no one, the path leads right through white people.

Yes, I know you thought it was already all about white people, didn’t you? Well, here they come again.

Even as the majority in the United States tends increasingly towards minorities and white people become the largest minority in the country, they are steadily becoming their own monolithic voting bloc. When the statisticians analyzed the path to electoral power in some of the elections where there were surprises, like Iowa, they found that rural white voters, even those that had been traditionally Democratic voters were going Republican now. Additional information indicates that the same conundrum exists in the Southern states which are now leeching themselves of Democratic Party representatives. The traditional political rule-of-thumb had been that if a Democrat in the South got 40% of the white vote, then with huge support among African-Americans and solid support among Latinos, they would win. Now it appears that Democratic candidates are lucky to be able to figure the math at 30% and are only winning 25%.

It gets worse!

Where Democrats and many Republicans had assumed the presidential electorate was stacked heavily in their favor with a coalition of African-Americans, Latinos, young people, and women, this white people power thing is a problem. Experts are noting that too many of the soothsayers were discounting the fact that President Obama in his two victories actually polled very well among whites outside of the South and in rural areas, especially in the northeast and Pacific states. A Democratic candidate would have to do about as well with whites to hold that coalition together even with the increased voter turnout that comes with a presidential election.

So the bottom line is that rather than it being a laugh line that the Republicans are a party of old, white men, this could be their ticket into the White House, especially if they have a candidate who doesn’t stink with Latino voters, who are more conservative than African-Americans, and make the mistake of wearing their misogyny on their sleeves.

It could happen, despite the numbers. We always knew in New Orleans that even with a solid 65% African-American majority that a conservative African-American that appealed to the business community and could pull 90% of the whites and a third of the black vote could win, and that’s how we got C. Ray Nagin as mayor for two terms. A Republican candidate like Jeb Bush or Mark Rubio who wasn’t crazy and polarizing could erode Latino support and confuse some of the other voting blocs with the big “if” being whether they could get through the primaries. A Democratic candidate like Hillary Clinton, who many have already conceded the nomination, could make it tricky because of her age with young voters, her baggage with all voters, and the 10-year hiatus on whether or not she could erode the white people power bloc of the Republicans.

Nothing looks easy for anyone today going into the 2016 contest. We’ve lived with white people power for years in the United States, so the notion that it could be back will provoke many screams in the night from sound sleepers throughout the country.