Paul Krugman, as occasionally happens, is wrong. States are not opposing Medicaid expansion, as he has repeatedly claimed, out of spite. It is not at all the case, as it must be for this "residual category" argument to be true, that politicians "spending large sums, in the form of rejected aid, not to help the poor but to hurt them ... doesn’t even make sense as cynical politics." Of course it makes sense. Krugman may not have lived in a place where it regularly happens, but those of us who have should recognize the practice quite easily.
This is a matter of paying for the "bus ticket out of town."
When I lived in Michigan, I remember a state legislator offering the solution to poverty in Detroit: "buy them a bus ticket to Chicago." (I think that when I lived in Illinois I may have heard the suggestion to poverty in Chicago "buy them a bus ticket to Detroit," but I'm not sure.)
They're trying to get rid of their poor people, Dr. Krugman! They're trying to get them to move to states with more enlightened social policies. That's conservative "social engineering" for you!
And far from being senseless -- it may work.
I'm surprised and a little disturbed that Krugman doesn't get this.
There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court decision upholding the law’s constitutionality also gave states the right to opt out of one piece of the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first.No, if the plan to drive the poor across the border works, they will save money. They will help their own budgets. They will aid their own economies. They will make poverty someone else's problem -- the problem of those "suckers" in blue states who do agree (as well they should!) to take federal money for Medicaid expansion. And voters in these Republican states, who understand this process even while Krugman does not, will give the politicians who arrange this sneaky maneuver political rewards. ("We've cut the number of people on welfare," the politicians will proclaim -- on their way to re-election.)
And why would they do this? They won’t save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I’ll explain later, it will probably hurt Republicans for years to come.
No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won’t just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens.
For this reason, they don't even see themselves as imposing "gratuitous hardship for some of our most vulnerable citizens." Wingnut-run Michigan doesn't (necessarily) want to see its poor people die; it wants to see them relocate to "enlightened" (snicker, snicker) Illinois, which (the reasoning goes) apparently wants more poor people or it would not have agreed to the Medicaid expansion. It's just a little coercion to get the poor to go to where they'll get medical care. "Yeah, they may be uprooting themselves and their communities -- but it's not like their leaving good jobs!" (the argument would go.)
Plenty of average, not-that-bright, internet commenters get that it's not just a matter of spite. I searched on the phrase "bus ticket to Chicago" and "poor": sure enough, lots of people "get the joke." There's this guy, talking about minorities in a small Arkansas town:
Some not-that-bright people in Texas get this (warning, link to Freep):Never in my life have I seen so much hatred and racism in such a small run down town like blytheville! It's pathetic! This town needs serious help or no one will ever think twice about moving here! This town has absolutely nothing positive to offer! Something has to give!!!!Give them a bus ticket to Chicago!
The solution is simple. Offer these “poor women” on public assistence a one way bus ticket to Chicago, Illinois or Oakland California or Mexico. Have them take their families along. Take them off the welfare rolls and move along. Shiela Jackson Lee will lose most of her recipients.It happened in Reagan's California, with the homeless and mentally ill:
In the pre-Reagan California in which I spent my childhood, there was no such thing as "homelessness."Attributing the strategy of rejecting federal money for the poor to "spite" fails to recognize the cunning of red-state Republicans. They're not imbeciles who can't stumble their way through a budget. They're just trying to dump their problems onto someone else to prettify their books.
And it's a myth that all State hospitals were abusive warehouses. I worked in one for years. The surroundings were spartan, due to budget issues, but the people who worked there were, on the whole, as competent and compassionate as anyone else in the nursing profession.When the State hospitals were closed, the residents weren't moved into idyllic country homes. They were turned loose on the streets. In which would you prefer to live, if you were gravely disabled: a spartan but comfortable hospital, or under a bridge? Those are the choices.
Here they were given a script for their meds, no money and a one-way bus ticket to Chicago. I can remember when they did that like it was yesterday.
In other words: they're at war -- with the rest of us. Let's treat them accordingly. If they successfully dump their needy onto states that do accept Medicaid expansion, whatever amount they save should be reduced from other federal appropriations and transferred to blue states.
Then -- and only then -- might we see them change their strategy. Because, until and unless that happens, their strategy is working -- whether Paul Krugman gets it or not.
11:47 AM PT: Update: thanks to emelyn for the correction! (We shall not speak of it again.)