Flawed Republican Logic: Georgia is Not Conservative and Healthcare is Not a "Handout"

The Republican head of the Georgia Senate's Health and Human Services committee says the state needs to “re-examine” expanding Medicaid.  State Sen. Renee Unterman (R-Buford) didn’t endorse the idea of Medicaid expansion under the Affordable Care Act, also known as Obamacare. Rather, she thinks the state should look at negotiating a federal waiver, as other Republican-majority states have done, to tailor how any potential Medicaid expansion would work…

"Right now, we’re just pumping out state dollars to stay in the midst of the crisis.”

The “crisis” Unterman is referring to is the struggle many Georgia hospitals are facing to keep their doors open. At least four rural hospitals have closed in Georgia since 2013.

Unterman said for the last two years state lawmakers have “propped up our state budget with immense amounts of money trying to manage our way through a crisis...” …

Georgia is one of 19 states that has not has expanded Medicaid. An estimated 400,000 residents fall in what’s known as the Medicaid coverage gap, meaning they make too much money to qualify for Medicaid, but not enough to receive federal subsidies that would help them pay for private insurance.

Under the ACA, the federal government expanded Medicaid coverage to all Americans under 65 years old whose income falls between 100 percent and 138 percent of the federal poverty level. That means the threshold for eligibility is about $16,400 for an individual in 2016, according to the National Conference of State Legislatures.

   - WABE.org "GOP Senator:  Georgia Should 'Re-Examine' Medicaid Expansion", June 7, 2016

Yes, Republican State Senator Renee Unterman admitted that Georgia Republicans refused to participate in Medicaid expansion for the working poor as part of the Affordable Care Act. 

Yes, since then, Georgia's healthcare system (if one can call it that) has fallen further into crisis, with hospitals closing, large swathes of the population - even those with health insurance - without access to healthcare. 

Yes, the Affordable Care Act is now here to stay. 

Yes, it's too late for the Georgia to change its mind and participate because the enormous federal funds that were offered early in the program are no longer available. 

But no, the Republican refusal to participate or to expand Medicaid to working poor Georgians was not a mistake. 

Extraordinary. 

What was even more fascinating was her rationalization for this catastrophic Republican error that isn't really an error unless you publicly admit it was:  Georgia is a "conservative state" and you don't want to give people a "free handout" (yes, she used this redundant phrase). 

Let's look at each of these justifications.

When she says that Georgia is a "conservative state" what she really should have said is that the Republican party of Georgia, which has had a strangle hold on Georgia law and policy so decided to reject Medicaid expansion despite widespread protest, is conservative. 

Georgia, if one dives into some basic demographics, is decidedly not conservative. 

According to the 2010 Census, 55.9% of the state is non-Hispanic white, and about 39% of white voters nationwide voted Democrat in 2012, so even if 70% of white Georgians are Republicans, white Republicans make up only 39.1% of Georgians.  Far from a majority (although thanks to gerrymandering and African-American voter suppression efforts, white Republican voters have far more representatives than do other groups). 

Over 30% of Georgia is African-American.   President Obama won 93% of this demographic in 2012, meaning that we can infer that about 28% of Georgia consists of African-American Democrats, only 11.1% less than white Republicans.

Hispanics of all races made up about 10% of the population.  Hispanics voted 71% Democrat in 2012 and we can assume that this number will surge thanks to Trump; assuming 80% vote Democrat, we can assume that another 8% of Georgians are Latino Democrats. 

3.2% of Georgia is Asian, a group that voted 73% Democrat in 2012 (adding another 2.3% to the Georgia Democratic column).

Adding all these constituents gives us a picture of Georgia as a far-from-conservative state:
            28%     African-American Democrats

              8%     Latino Democrats

              2.3%  Asian Democrats

            16.8%  white Democrats

            ===

            55.1%   Democrats

Over half of Georgia can be inferred to be Democrat.  So why don't Democrats control over half of the Georgia House and Senate?  Why is not one Georgia Senator (sent to Washington) a Democrat? 
I report, you decide. 

The point here is that this white Republican cannot claim to speak for the 55% of the state who is not Republican and the 61% of Georgians who are not white Republicans.  It's narcissistic for her to claim all Georgians are "conservative" simply because she is. 

Now let's move on the "free hand out" [sic] comment.  Once again, this reflects incredible ignorance about how health care works and how it differs completely from cash benefits.

If someone has leukemia and we as a society or a state decide to make sure that that individual has access to life-saving treatment, this doesn't represent a handout. It is simply the right thing to do.  It's the fulfillment of a basic human right to life liberty and the pursuit of happiness and to health care as established in the Universal Declaration of Human Rights which the United States signed (and wrote).

Put another way, healthcare is not a luxury, but a fundamental human right to which all citizens regardless of economic status should have access (that's what makes a right a right - you don't have to buy it). 

Why do Republicans, who repeatedly and noisily identify as Christians, followers of a man who gave away free healthcare and instructed his followers to do the same, are consistently worried about moral hazard? 

Moral hazard is the idea that if I give you $5 to help you out today, you might be a little less likely to save or earn $5 tomorrow, figuring you can always come ask me for it.  It's an over-milked cow of the religious right, an idea about which Jesus spoke not at all.  And it doesn't apply at all to healthcare.

Why not?  Imagine if the price of a leading breast cancer chemotherapy were given away free of charge tomorrow.  Does this mean that all those scheming poor people Republicans fear and loathe would go out and develop breast cancer to get their handout of free chemotherapy?

Of course not.  The demand for a given treatment is ultimately a function of the prevalence of that treatment.  If .5% of Americans have a disease, 99.5% of Americans will not seek treatment for it, no matter how low its cost to them. 

The idea that giving someone chemotherapy might somehow make her a slug or a permanent ward of the state is one that no serious healthcare economist shares.  Of course, it's hard to find an issue on which Republicans don't act in a very illogical and strange way these days, but there is an argument to be made for limiting or at least strictly regulated the spending of healthcare dollars. But this is a conversation that should be occurring far above the level of the individual citizen who requires life-saving health care.

To consider a simple example, let's say a patient with multiple sclerosis takes a pill that costs $2 to manufacture but for which the drug company demands $100.   The Republican approach to healthcare costs is to punish the poor patient for "spending" that $100 (shame on them!).   Yet the consumer has no power whatsoever over the cost of the treatment (in an efficient, transparent market, the consumer could buy the lower-priced product of a competitor, but healthcare is neither efficient nor transparent, and in many cases there are no low-priced effective substitutes). 

If, instead of blaming the sick and the poor, Republicans advocated doing what governments in every other developed country do, namely negotiating with the drug company or even lowering the price by fiat (through the same regulatory mechanism used by government to lower utility prices and keep them regulated).   The pay-off from reducing the $99 per pill premium will be far greater than making the MS patient either forego treatment or face bankruptcy.

If you think that this is an exaggeration, you have not been following the economics of pharmaceutical pricing and healthcare costs. It is beyond idiotic and cruel to attempt to balance excessive healthcare costs generated by large pharmaceutical companies on the backs of the poor and the working poor.

And the idea that someone with a serious chronic illness doesn't have "skin in the game", to use this Republican's metaphor, is insulting and stupid.   How did we get to a place where to be old and on multiple medications means you must be impoverished or facing financial ruin?   This is no way to run a healthcare system and it all starts with the flawed Republican assumption that healthcare is some sort of luxury to which the poor are not entitled.