Tuesday, January 20, 2015

Martin Luther King and the Moral Case for Medicaid Expansion

Yesterday, on the anniversary commemoration of Dr. Martin Luther King’s birth, I went to see Selma—the movie, not the place.  The biopic is everything I expected—a moving, enthralling, inspiring yet immeasurably sad account of Dr. King’s leadership in organizing a march from Selma to Montgomery, Alabama in support of voting rights.

The movie does not cover the next great cause planned by Dr. King, a “Poor People’s March” to call for an Economic Bill of Rights.  As journalist Gary May recounts, “King had hoped to recreate Birmingham and Selma: organize the masses, demonstrate, touch the conscience of the nation, and thus force the government to act. It had happened in 1963 and 1965, so surely it could happen again.  But it didn’t.”   Dr. King was assassinated on April 4, 1968.  Just a little over a month later, his widow Coretta Scott King led a march of 5000 people calling for an Economic Bill of Rights (my late father Jack Doherty was one of the marchers), yet “No Economic Bill of Rights was ever created and the campaign produced only minimal results — more food stamps became available and funding for Head Start programs in Mississippi and Alabama was increased” observes May.

“Had King lived, it is doubtful that he could have achieved more” May concludes.  “The American political system [today] is incapable of producing the massive changes King prescribed in 1968 . . . That such changes are needed is indisputable but how to achieve them in a time of institutional and political paralysis is the million dollar question that lacks a practical answer. . . The unfortunate history of the Poor People’s Campaign and the failure to deal with contemporary outrages is not a prescription for inaction, however. Quite the contrary.  King put it best: "I can’t lose hope," he once said, "because when you lose hope, you die."

What if, though, the country decided to act on a contemporary issue (although it has its roots in the Civil Rights movement of the 1960s) and agreed to expand the Medicaid program to the poor in every single state?  While it's risky to speculate on how a person from the past would view any current issue, is there any reasonable doubt that Dr. King would continue to believe, if he were alive today, that the United States has a moral obligation to provide affordable coverage to everyone, and especially to the poor?   He reportedly once said that “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  The Affordable Care Act, and particularly the expansion of Medicaid, was created to provide access to coverage for the tens of millions of poor and near-poor, and it is starting to achieve this—more than 10 million previously uninsured persons gained coverage in 2014, and millions more will get coverage this year.  But in the majority of states that have refused to accept federal dollars to expand Medicaid, the truly poor (people with incomes at or below the poverty level) have no access to subsidized coverage under the ACA—because the 112th Congress and the Obama administration had never envisioned that the Supreme Court would make Medicaid expansion voluntary, and that a majority of states would then turn expansion down.  More than 7 million poor people fall into this coverage gap.

The good news is that there are a growing number of states, with Republican governors, that are seeking to expand Medicaid—but with changes that need to be approved by the Obama administration.

We still have a long way to go before every poor person in the United States has access to coverage.  I can think of no better way to honor Dr. King’s legacy than for physicians in every non-expansion state to urge their governors and state legislatures to close the coverage gap for their poorest residents by urging them to expand Medicaid—not next year, not five years from now, but this year, now, because “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Today’s questions: What do you think Dr. King would say to the states that refuse to expand Medicaid? What will you say to them?


Harrison said...

The choice by some states to refuse Medicaid expansion gives political advantage to the Republican party in those states. And it is the politics of us vs them. The population that would stand to gain is not typically a group that votes, and if they do vote they tend to vote for Democrats. So it is possibly fair to make the case that the Medicaid expansion was legislation designed as a gift to constituents. However, that population doesn't really vote. So it isn't one of the smarter political gifts ever given.
The choice to oppose it though is a smart political move for a party that gets votes from people who like to view their status as being threatened. Those that feel threatened look at the economic pie as something that has to be shared. They see it as zero sum. So, there is a certain amount of money and they don't understand why their share has to be given. And then they start throwing around divisive terms to characterize the recipients of "their" tax money. Of course the most hated is the "illegals". And in the community that hates that group, their role is very much over blown.
The politicians sew that hate.
So we can all remember the Congressman who called out from the seats that the President was lying. The comment that he was calling him a liar about was the President's assurance that money in the ACA would not go to undocumented people. And the language of the law specifies that. People who work in free clinics since the law has gone into effect also know for sure that that is the way it has played out. Those clinics have seen drops in the number of people, and those who do need to use the clinics are undocumented.

Anyway, politicians who oppose Medicaid expansion argue to their constituents that they are watching out for them. They argue that they are protecting their piece of the pie and their tax dollars.

They also know that their constituents believe that the people who are very poor are their due to slothfulness.
They do not feel that this should be rewarded.
They strongly believe that Welfare Fraud is one of the biggest wastes of tax money and so anyone who opposes putting money into that gets their vote.

None of it is true.
But it is good politics for the opposition.
It sews hatred and divisiveness, but it solidifies the Republican base around themes that oppose illegal immigration across our Southern border, and using government money for programs to combat poverty, and in general that oppose giving away government money.

Of course they move quickly past government money give aways to the financial industry, and to the gas and oil industry, and to price supports for alcohol from corn as an additive to gasoline, and to the defense industry.
Those things are American, and it would be unpatriotic to oppose them.

The Congressional Republicans have created a hateful monster. They have generated a lot of political capital by dividing the country. Now they control Congress and have to demonstrate that they can govern. In order to do so they have to either reign in their members who were elected by espousing hate, like Senator Cruz, Senator Ernst, Congressman Gohmert, Congressman Steve King, or they have to work with Democrats.
They cannot continue to vote time and time again to simply repeal the ACA. Even if it gets a vote in the Senate, which it will not because it will not get 60 votes, it would get vetoed and there will not be 2/3rd's of either house to over ride the veto. They can try to piecemeal knock the bill down. The Supreme Court may help them with that. It will do so at the cost of it's own honor, but it chose to do that in 2000, when it chose to stop the Florida vote. So it wouldn't surprise me.


PCP said...

My goodness Harrison. A liberal partisan rant, even for your standards!
The irony is much of what you said pertains exactly to the U.S. President. His SOTU was the most partisan, divisive one after the double shellacking in Nov. that anyone has ever seen. If he claims to be interested in reaching across the aisle, his words and, his actions sure don't show it.
And I'm trying to be very objective here. I saw some of that with Bill Clinton in his second term, but not with Barack Obama.
Any neutral observer would acknowledge that policy has moved left over the last 6 yrs. Perhaps not to the extent of your liking, but Obama did get the ACA passed and the Supreme Court let it slide, taxes have gone up on the wealthy, both via the ACA as well as post 2012 Obama reelection, and spending on welfare continues unabated, we even got a 800 billion spending bonanza from Democrats. Yet none of this even registers to those of you on the left. In fact I would say that for over 50 yrs both on social and economic policy, things have moved left. I assume only a societal collapse will convince you of the foolishness of veering repeatedly in one direction.
Anyway, there is deadlock in this country and it will not be resolved anytime soon.
I must say however, Mr Obama has been a total disappointment as president.

Harrison said...


Social? I think it is undeniable that we have socially moved to the left over the last 60 years.
But, Geez, I would hope so.
Voting rights? Overt racism? Segregation?
Are you suggesting we somehow move back?
Our nation has changed. Laws and attitudes have to change with it.

We do so many things better now as a society as compared to 1965, it just isn't comparable.

Economically we are also doing better.
Home ownership is better.
The stock market is no longer just for the elite.
My parents didn't own stocks in 1965. They couldn't afford a broker. They had money in a savings acct, and maybe a CD, and the bank I guess served as a defacto broker with guaranteed money. But they didn't have retirement money that went up and down with the Dow Avg.

I guess there really isn't any band now that compares to the Beatles. So I'll give you that.

But what is it you are expecting will happen with this societal and economic march to the left?

I would argue that the weaknesses in the ACA are the concessions to the industries that run for profit health care.
If we move away from that (even more to the left) we have a more stable health care system that can focus on cost effective strategies to reduce costs, and negotiate with provider groups with fewer for profit middle managers.


ryanjo said...

The sad state of the Medicaid Expansion is just another consequence of letting a confrontational and dollar-driven political system determine medical priorities. Of course the expansion would be opposed as too costly for some states, and Medicaid payments to doctors would be cut! Every action of our political leaders is posturing for the "base" and consolidating more money & power. When are we as a profession going to work to get the politicians and for profit scoundrels out, instead of facilitating their hoaxes?

Maybe our national medical leadership might remember this quote from Dr. Martin Luther King Jr: "In the End, we will remember not the words of our enemies, but the silence of our friends."