Sunday, November 22, 2015

Vulgarians at the Gates: Turning Blue States Red

Finally, the central problem for the Democratic party has finally been addressed openly, that 800 pound gorilla is finally getting his due.

Not since Thomas Frank wrote "What's the Matter with Kansas?" in 2004 has any prominent voice really addressed the mystery of why people from states most dependent on government assistance programs (welfare, Food stamps, Medicaid) vote against the very Democrats who support these programs. 
How did she vote?

It's come to the point where Democrats drive around with bumper stickers saying, "Got Medicare? Thanks Democrats," and "Got Social Security? Thank Democrats."

But today in the New York Times, Alec MacGillis addresses the issue head on in "Who Turned My Blue State Red?"  And he reports what I've seen in my own clinic for years:  People who live in economically depressed areas, who have struggled to get one rung up the economic ladder, deeply resent those below them, who do not appear to be trying at all. They loathe the undeserving poor and do not want to help them.

It is the forty year old woman who comes from a family of eight, who got pregnant at 16, divorced her hard drinking none-too-constant husband at 17, got government money to make it through community college and got some sort of nursing degree, maybe a LPN, then kept working to get a diploma RN, who sees people on welfare "waltz" into the dialysis center where she works making no effort to go to work themselves. 
(Of course, dialysis patients need to be dialyzed three times a week, usually all morning so their job opportunities may be limited. But I've heard the same from nurses in other sorts of clinics where the patients are not as ill.)
What do these two think of Obamacare?

Living among people at the bottom of the ladder, shopping at Walmart, seeing the losers in this rigged capitalist economy, makes people think two thoughts: 1. I'm so much better than these people. I struggled to get up to a better life. 2. But here I am with them: Am I really so much better? Have I really escaped? If I throw in my lot with Democrats, am I not going to be wind up in the same room with these dregs?
Is she voting for Trump?  Watches Fox News.

Joining the Republican party is like joining the country club. It's like getting your kid admitted to Harvard, when you still live in some down trodden slum. You are rubbing shoulders with the rich now. You are in the club.

A prime example Mr. MacGillis raises is  Paul  LePage who was elected governor in a state which was third in the nation for food stamp use, running on an anti welfare platform, refusing to expand Medicaid under Obamacare which would have covered 60,00 people, re-instituting a work requirement for food stamp recipients, barring anyone with more than $5000 in assets from receiving food stamps, attempting to drug test welfare recipients to prove they are not using their money to buy drugs, cigarettes or alcohol.  Mr. LePage, who trumpets his own story of rising from desperate poverty has no sympathy for those who do not work as hard as he did. "I'm not going to help anybody just for the sake of helping. I'm not that compassionate."

Did he vote Democratic?

His appeal is to the people who live pay check to pay check, feel financially threatened and precarious and feel burdened by taxes they think are being given away to people who they hate.
Gov. LePage says he abuses Food Stamps. 

 These are the voters who are the gas station owner, "the sheriff's deputy, the teacher, the highway worker, the motel clerk" in other words, the people who have to deal daily with the public, and often a public at the bottom of the economic scale. They see the "shoppers of Walmart" daily and they do not like what they see. They have lost all sympathy and do not want to be associated with them any more than they have to be and they do not want to give them money.
Does she read to this kid at night?
Dorothea Lange Poor

These people hate the "welfare queen" that fictional creation of Ronald Reagan who lives like a queen on the backs of hard working people. 

Then there is the other group, the really destitute Mr. MacGillis saw in Kentucky, the rural poor who get Obamacare but don't vote for Democrats because they simply don't vote, and they do not know who in government is giving this gift to them. They are so disconnected from information, they just don't know who their friends are or who their enemies are. Even CARE packages dropped into Afghanistan, Pakistan after an earthquake have big letters stamped on them: "From the USA," but in Kentucky these people don't know who is helping them, don't care, don't vote. 
Insured by Obamacare. Hates Obama.

A Democrat in Kentucky was asked "whether or not Republicans were afraid of displacing 400,000-500,000 people who have insurance" and he replied "No: people on Medicaid don't vote."  He discovered that when he lost re-election. Representing the truly destitute doesn't pay. You won't be in office for long.

None of this augers well for Bernie Sanders. 

Maybe the core psychology, the true appeal of Donald Trump, is that the deputy, the motel clerk, the nurse, the gas station owner love to think they can be in the same club as this very rich man, and just as important by joining the Republican party, by going to their rallies, they can leave behind the "trailer trash" they so ardently despise. 
Owns assault rifle. Listens to Rush daily.

It's the upward mobility thing. 

Republicans have made no apologies for wanting to limit the number of people who can vote. Even my own father, a life long Democrat, was dubious about making voter registration too easy, registering people automatically when they get their driver's licenses or registering them outside Walmart.  Do you really want people voting who never read a newspaper, who don't listen to the news, who are uninformed? People like the "shoppers of Walmart" electing our President, our senators and congressmen?

Should we not establish, as a basic test for voting the requirement you make at least some effort to register and then to vote?

If the people of destitute Eastern Kentucky are so ignorant, so apathetic, they do not even care to ask who gave them their health care, why should we help them? If you give people health care, food, shelter and they simply take it but show no gratitude, act as if they are entitled to it, do not respond by going out and finding a job, by working hard, why should we make the effort in their behalf?
Not going to the local Democrats meeting tonight.

I certainly am not immune to the Paul LePage reaction when I see patients in my own clinic who are "disabled" by physical problems which do not strike me as in any way close to disabling, who have much better drug coverage on Mass Health than my patient who works three jobs (one of them at Walmart) and spends $300 a month for insulin. Some of the patients I see who draw from Medicaid and from Medicare disability appear to be not suffering but whining. Of course, I remind myself, would I ever want to live their lives, to be sitting at home watching TV, trapped in a public housing apartment, having no hope for a better future, just existing, taking up space and not feeling useful?

The answer, of course, is yes, there are slackers for whom we have little sympathy, but for every slacker there are ten hard working people, working two or three jobs who have no shot at health insurance without Obamacare, who have kids who have not yet had a chance and who, given some day care, some pre school programs and good public schools may make us all proud some day.

During the Depression, Dorothea Lange took photos of America's poor which evoked deep sympathy for those struggling. One might ask whether the poor have changed, from decent folks who were simply ruined by a corrupt capitalism into reprobates who deserve their wretched lives or whether it is simply  the images of what it is to be poor have changed. 

The basic question is whether the people in the bottom 10% are worth working for.  Or actually, we might ask, looking at that famous pie graph, are the people in the bottom 90% worth working for?

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