HEALTH CARE/Joan Retsinas

Government’s War on the Poor

The rich/poor gap in America widens, prompting dismay among both traditional liberals and traditional conservatives.

For liberals, government exists to help the people left behind in a surging capitalist economy. While Uncle Sam needn’t lower the incomes of the rich, this Uncle should at least raise the incomes of the poor, well above subsistence. As for classic conservatives, they espouse enthusiasm for laissez-faire Darwinism, letting the rich prosper; but those old-school conservatives have no appetite for the visible signs of that world-order: the street-corner begging common in the developing world, with governments unable? unwilling? (is there a difference?) to alleviate abject misery. So conservatives in this country traditionally let government offer a “helping hand” to the poor, enabling them to pull themselves up by their proverbial boot-straps.

That was old-school thinking, before the Tea Party returned government to its purported roots, where ideology reigned. The impact of that mind-set: a war on the poor. This war is not waged with weapons, but with decisions. The target: the health of the poor.

Consider a few instances where government wielded its power against the poor.

The Decision Not to Expand Medicaid

President Obama’s Affordable Care Act offered states the chance to expand Medicaid to poor people not otherwise eligible – including adults without children. Uncle Sam would pay the full costs until 2016, then 90% of the costs. To date, 21 states have opted not to expand Medicaid; 3 states are mulling the decision.

Expanding Medicaid would give more people insurance, provide more healthcare jobs, lead to a healthier population. Consider the benefits that would accrue if Florida expanded Medicaid: 848,000 more people insured, 123,600 more cholesterol screenings, 25,000 more mammograms, 52,000 more Pap smears (http://www.bradenton.com /2014/07/13/5250944/benefits-of-medicaid-expansion.html?sp=/99/196/). The state would save on uncompensated care.

Yet Florida, like a host of other states, refused to give poor people the basic protection of health insurance.

The Decision Not to Give Veterans the Kind of Care That Decision-Makers Enjoy

In a long-ago past, Uncle Sam gave veterans generous housing and education benefits; in fact, the World War II health care insurance coverage of the families of people serving overseas was a precursor to the decision to encourage widespread health insurance. Yet a frugal ideology reigns over the Veterans Administration: we now treat too many veterans as expensive line-items to be juggled, to be wait-listed, to be cast aside. The scandal at one Arizona Veterans Hospital prompted a larger investigation. According to an internal Veterans Administration audit, more than 120,000 veterans have been left waiting or went without care. Crucially, schedulers were told to juggle figures to make the waiting times seem shorter. (“Audit: More than 120,000 veterans waiting or never got care”. CNN. 10 June 2014. Retrieved 12 June May 2014)

Today’s military is volunteer; we have no draft. Not surprisingly, the bulk of enlisted servicemen and servicewomen don’t have wealthy families; many will not find well-paying jobs once they return home. Now it seems that the government won’t even give many of them health care.

Texas’ Decision Not to Institute Workmen’s Compensation

Right-wing ideologues tout the “Texas miracle:” one third of the new jobs created in this country over the past decade were created in Texas. And the miracle-workers cite the state’s antipathy toward regulations. They posit a false dichotomy: regulations versus jobs.

Texas doesn’t require companies to pay into a state system. It doesn’t stringently regulate the private workmen’s compensation companies. To date, as many as 500,000 workers lack basic workplace protection; and almost half the private policies include no death benefits. Most Americans take workmen’s compensation systems for granted. Early 20th century Progressives touted the system. Horrific workplace injuries spurred a public resolve for this insurance.

In Texas, spurred on by a right-wing antipathy toward government, that public resolve has weakened (http://apps. texastribune.org/hurting-for-work/). The not-surprising downside to Texas’s jobs: the state leads the nation in workplace fatalities.

Government is not simply neglecting poor people; the government is endangering them, in effect waging war on them.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, August 15, 2014