One of the benefits of throwing a few bucks at Charles Pierce at Esquire is getting on the list for his weekly email. This week it featured an interview with Ken Starnes, a physician working along a rural stretch of the Arkansas-Missouri border.
Starnes’ experience provides a natural way to observe what happens when insane ideological commitments trump obvious public policy wins. He sees and accesses hospitals in both states. His patients come from the same demographic in both states. There is only one key difference between them: Arkansas came up with a Rube Goldberg way to implement Obamacare’s Medicaid expansion, while the people he sees from the Misery side of line are governed by GOPsters so doctrinaire that they refused the Black-President-tainted free money rather than deliver care to their citizens.
Stearns:
…there is a big difference between the way I treat people in Arkansas and the way people I treat in Missouri because of that. Here in Arkansas, I could probably get you to follow up with somebody, or you’re on your medicines. I was in medical school when they expanded Medicaid, and all of a sudden you have people coming in who were bad asthmatics, who had not had inhalers for years. Or diabetics who had not been on medicine for years. And the numbers turned out that these people were getting better health outcomes in Arkansas.
In Missouri, they have not done that—take the free money as you said—and the health outcomes are different. When I’m working in the emergency department, a lot of what I’m looking for is, I may not have to put this guy in the hospital, but what am I gonna do with this? If he’s not sick enough to come in, but this can’t be ignored. If I can’t get you in for a follow-up with a primary-care doctor because you don’t have insurance, or you do, but there’s not one available to you, I can’t really fix your problem. I’m just going to wait for it to get worse and for you to come back and see me. That’s the frustrating part.
Republican AGs are suing to eliminate the ACA altogether, including, obviously, the Medicaid expansion. The Trump administration supports that effort. If they win, Missouri will be the model for the US. The Supremes will hear the case in October. I hope (and expect) that Biden and Democrats all the way down the ticket will be ready to go with the appropriate message when that happens. (Remember–whatever folks think they think about Obamacare, that other thing, the ACA, and specific benefits like having health care at all, remain popular to very popular.)
But what about the GOP Obamacare replacement plan, you ask?* That has remained consistent since 2010, at least. It’s only virtue is that it is simple:
Die sooner.
Which looks way too damn likely is what’s about to happen in a bunch of places that for ideological reasons have neither extended the reach of their health care systems nor taken seriously elementary public health techniques in the face of a pandemic.
This thread: it is as open as Trump wants his convention to be.
*You don’t…because you know better. But roll with me.
Image: John Constable, The Hay Wain, 1821.
RepubAnon
My fantasy is that a Trump rally’s invitees are all Democratic activists… and when Trump starts speaking, they all drop trousers, moon him, and start booing. Probably cause a coronary for the Apricot Hellbeast.
debbie
Let’s end the taxpayer-funded healthcare and pension programs for these jerks before we talk about ending healthcare for the taxpayers.
Brachiator
The sad thing is that some of the people in Missouri and other states have come to accept their fate. They have fully absorbed a total belief in rugged individualism, the idea that big government that is used to help people is an absolute evil, and that patriotism means that you must be willing to die to prevent a creeping socialism from taking over the country.
Fortunately, you will be welcomed with open arms by the Baby Jesus when you die, because God Almighty votes Republican. It’s all right there in 2 Libertarian.
West of the Cascades
@RepubAnon: Trump won’t have any problem looking at someone’s bare ass — he sees one daily in the mirror.
p.a.
Die sooner. 2010? You mean 1947 when Truman first floated gvt health insurance and it was DOA thanks to repubs and southern dems.
https://www.history.com/news/harry-truman-universal-health-care
West of the Cascades
@Brachiator: There has to be hope, though – Kentucky threw out the idiot governor who tried to claw back the expansion, and almost as many states as didn’t originally expand on January 1, 2014, have since expanded as states that have still refused to (12 have come around and expanded since 2014, 14 still refuse to adopt – data at https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/). I sure hope that people in the non-expansion states see this as hopeful and keep working on it — and a new Democratic Senate/President can offer some additional incentives to help convince more to do so.
Ruckus
I know this sounds insane but some of the concept of reasonable, modern healthcare may be simply because it’s modern. It wasn’t in the bible so it shouldn’t exist. Go back 70 yrs or more and health care was extremely limited. I had a tonsillectomy 64 yrs ago and the anesthetic was ether, applied by drops onto a mask. The pandemic of 1918 was much worse because medicine was barbaric. And it was barbaric because that’s as good as it had gotten. 102 yrs ago is within the lifetime of living memory. It’s only really been in the last 60 yrs that tremendous progress has been made in medicine.
So I have to ask, what is the end goal of conservative ideology? Strictly power or more?
Conservatives want to regress a lot farther than 60 yrs. In pretty much every way. It’s non sensical but then so is their entire political concept.
mrmoshpotato
This fucking sack of walking orange shit…
Kent
My wife did her medical residency at a federally funded clinic network in Texas. And then we stayed on for a few more years as she was offered a good faculty job and we had kids in school. This was during the entire ACA implementation period from Obama’s election until a few years ago.
The retirement plan for doctors at the clinic was a profit sharing plan (similar to a 401(k) except that they can give more to higher paid employees). And every year after about 2011 the profits just keep plummeting along with salaries (lack of raises) and so forth.
Why? Because Texas failed to expand Medicaid of course. All that indigent care that would otherwise be paid for my Medicaid comes directly out of profits. It was a big clinic network and full of good old boy Texas GOP doctors who were all against anything Obama. And I never met a single one of them who was able to draw the direct connection between Texas’ refusal to expand Medicaid and their dwindling economic prospects. They would rather earn $50,000 per year less than go along with expanding the ACA. That is actually what I calculated the lost wages and retirement benefits cost my wife.
After a while we eventually just said “fuck the lot of them” and when the oldest daughter graduated HS we got the hell out.
Brachiator
@Ruckus:
Republicans with money and assets want state of the art medical care for themselves. They know what the good stuff is and stock up on it. Plutocrats hopped on their private jets and flew to spots where the Pandemic was under control. They bought up test kits for themselves and their servants.
Shit, four Supreme Court justices ruled that idiots should be able to crowd into churches and get infected by the virus. Oddly enough, these justices were in Lockdown and delivered their votes and opinions remotely.
Conservatives want the good old days for other people, not for themselves.
mrmoshpotato
@Ruckus:
I’m gonna go with controlling every aspect of the life of people who aren’t straight, white Christian men, Alex.
I’m sorry. You have to answer in the form of a question.
Brachiator
@West of the Cascades:
The Democrats should almost be able to win on this alone. Trump and the GOP keep yelling about repeal and replace. But they have nothing, have not even pretended to offer an alternative and straight up lie about protecting people with pre-existing conditions.
The Democrats can easily demonstrate that their proposals save lives.
dnfree
@Ruckus: interesting. I was scheduled to have a tonsillectomy in 1956 because I had frequent bouts of strep throat. It was postponed because that was a bad summer for polio, pre-vaccine, and then I just quit having strep throat. All I knew about the surgery was that you got ice cream afterwards.
cope
I too have tossed some dollars into the Esquire purse for added Pierce benefits. Today’s email column is a good first-person description of the sense of dread about a resurgence of the virus as well as a good real world illustration of the fractured nature of our health care system.
Just a suggestion but maybe donations like I made to BJ could also be tied to some similar incentives, whether it’s some kind of extended content or elimination of ads or maybe even just an appreciative email message.
Kent
Honestly I doubt it. As I explained above, if you can’t even convince the doctors in Texas who would directly benefit financially from ACA expansion, then you probably aren’t going to convince much of anyone. Any message you try to sell to low-information voters in Texas is going to be absolutely overrun by a tidal wave of crap from Fox News, Facebook, and so forth.
Yes, there are millions of educated Democrats in a state like Texas. But they are a LONG ways short of turning the state legislature and governor’s office Blue, which is what would be necessary to expand Medicaid. Texas doesn’t have an initiative and referendum process like some other states, ACA expansion isn’t something that can be put on the ballot directly. Has to come through the state legislature.
Ruckus
@Brachiator:
Wealthy Conservatives want the good old days for other people, not for themselves. They want the best for themselves, yes, and they want everyone else to support them in this so they do everything to convince their side of the aisle that politics, life in general is hard and causes suffering and suck it up and vote conservative. And they want all of us to do this, which most of us see as bullshit. And this has never changed over hundreds of years.
I borrowed your phrase as you are correct, I didn’t state it as well as possible.
Ruckus
@dnfree:
As I understand it, this was a pretty normal procedure at the time, and has since gone out of common practice as more was learned about what the tonsils are there for. Here’s a Mayo Clinic page on this.
And by the way, yes I got ice cream. It didn’t help. Not funny side story, the kid in the other bed in my room was getting a circumcision. He was 7 or so and his parents had given him a line of unrelenting bullshit so he thought it would be great. One of the most annoying people I’ve ever had the misfortune of being forced to endure, telling me how great this was. I wasn’t convinced. When he woke up after the slicing he was strangely silent and obviously not enjoying the concept anymore. I learned early that some people can be convinced of anything. Like slicing up your penis is going to be fun. Or that medical care is unimportant. Or that things were better 70 yrs ago. Or that it’s just the flu. Or that shitforbrains is smart or human or rich, or gives a fuck about you, or is in any way sane.
debbie
@mrmoshpotato:
Send him the bill for the waste and replacements. Shame him.
evodevo
@dnfree: Yeah, same here, only in 1952 in Kansas. The polio epidemic scotched that. And the ice cream thingy was how they suckered all us kids in lol. 5 or 6 years later my sister had the operation, and after I saw what SHE felt like, I STILL have my tonsils, thank you very much…
Mart
@mrmoshpotato: Perfect summation of Trump’ s Presidency.
I live in MO, near STL. Fuck fucking Senator Josh Hawley who beat Claire McCaskill largely by an ad with his handsome family and him stating his son has pre-existing conditions, and nobody will work harder to protect pre-x than Josh Hawley; all the while he was the MO FUCKING AG who joined the lawsuit to end the ACA. We were on the ACA here for 1.5 years. The first year we had one company to choose from, and had to go to all new Drs. Old Drs staff was always rude when asked if they accepted the ACA plan. This year we had a choice of two providers, and most of the old Drs were on the new plan, but it was a bit more out of pocket. As long as I kept our combined 1040 income under $45K, it came out to about $350 per month with a $6k deductible. Doubt the poor white folks of the Ozarks have a plan to choose from, or the ability to absorb the $6k deductible or the $350/month for premium.
AnneWith
@Ruckus:
I had my tonsils & adenoids out in 1972 because of recurrent ear infections. Mostly what I remember is being pissed because I didn’t get any ice cream in the hospital, just ice chips & orange juice. Totally unfair!
rikyrah
@Brachiator:
At the very least, Democrats should put it on the ballot in every state that hasn’t expanded,
Nora
@rikyrah: Yeah. Make it clear who’s against giving you decent health care.
Kent
Not possible Not every state, especially southern states like Texas even has the initiative and referendum process in the state constitution. In TX the only way laws get changed is through the legislature. Period.
Death Panel Truck
Some reporters are really fucking dumb. An orange baboon stomps into the facility without a mask, has his picture taken sniffing one of the swabs, and Woodward and Bernstein can’t suss out why they had to be destroyed.
Ruckus
@AnneWith:
As I said, it didn’t make a bit of difference, I couldn’t even get one small scoop down. On the plus side it made boot camp a bit less annoying, remembering what I’d been through did give me some perspective not all that many years later. Although finding out that tonsils are rarely removed now, not that they needed to be then, but it was found out what tonsils actually do and it turns out they have a pretty necessary function, sort of the first line of defense against disease. They get inflamed fighting off infection. I wonder why olds are so susceptible to COVID, could it be that tonsils might actually help keep someone from either getting or getting the disease as bad?
Geminid
Governor Northam and the Democratic minority were able to put Medicaid expansion through in 2018 with the help of 11 Republican state delegates and 3 state senators. The Democrats had just picked up 15 House of Delegates seats, even though it was a map gerrymandered by the Republicans in2011, so the Republican leaders were scared. Most of the Republican “defectors” withstood primaries. Medicaid expansion was just common sense, and only the ideological opposed it. Northam announced last month that over 400,000 Virginians are now covered under expanded Medicaid. In the 1870’s German Chancellor Otto von Bismark was instrumental in creating a system of universal health insurance. He was a conservative nationalist who reasoned that a strong Germany needed strong and healthy Germans. Republican leaders should apply this analysis to the US but won’t.
ixnay
@mrmoshpotato: We live up here, but in the (only slightly more civilized) west, What I saw was they only ran the line for the duration of the bullshit photo op. So, not a full days production, but as Charlie says, What a colossal dick. And right, anything that was made while he was there has been shitcanned. Of course they also lost the entire days potential production.
fake irishman
I think this is a dead thread, but I want to trumpet loudly that Missouri has a chance to expand Medicaid in the primary election on August 4 (Governor Parsons put it on the August ballot in hopes the lower turnout will spike it after several lawsuits and legislative maneuvers failed to derail it) You can help the effort in Missouri here.
Oklahoma has an election on June 30 in which Medicaid expansion is on the ballot in Question 802. You can help that effort here.
I’m in for $100 in both places; but I’m sure they need phonebanking and perhaps postcards and other turnout help. Give what you can and remind your friends, nephews and random in-laws who live in the states to vote. More than 300,000 people — and probably a lot more with the economy tanking– will get health coverage. I expect perhaps our friends Dave Mayhew and Richard Anderson may do a post on this soon (or is that Anderson Mayhew and Dave Richard? I just can’t keep them all straight).
Pghmike
Can anyone explain to me why you’d wait fora final ruling before hammering republicans up and down the ballot for trying to kill Medicaid and protection for people with preexisting conditions??
Helen
Nebraska ,a deep red state, passed Medicaid expansion by referendum on 2018. The Republican governor, Pete Ricketts, has decided that it will take two years to implement. It will not be available until October 2020.
Barry
@ixnay: “What I saw was they only ran the line for the duration of the bullshit photo op. So, not a full days production,…”
Which means they still lost production due to having it shut down for the photo op.