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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.

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.

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.)

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:

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!
Some not-that-bright people in Texas get this (warning, link to Freep):
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."

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.
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.

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.)

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Comment Preferences

  •  Red-State rejection of Medicare expansion is not (22+ / 0-)

    just a red-state issue.  We have a right to travel in this country -- and those poor people will use it, if they have to do so to save their lives.  There will have to be a federal response to may them pay for trying to make the rest of us pay.

    "I love this goddamn country, and we're going to take it back."

                                                           -- Saul Alinsky

    by Seneca Doane on Sun Jun 09, 2013 at 11:25:58 AM PDT

    •  And then, with the reduction in spending (1+ / 0-)
      Recommended by:
      Seneca Doane

      caused by those poor families no longer spending their meager income - some perhaps from the US government - in the local economies, these states will see themselves continue their long slide to the bottom.

      They think that exporting their poor will solve their problems and make them prosperous. It won't. I'm no economist, but having seen enough of the debate over the stimulative effects of various programs, it would seem that driving out people who spend every dime they get is not a good way to stimulate the local economy.

      Free: The Authoritarians - all about those who follow strong leaders.

      by kbman on Mon Jun 10, 2013 at 12:13:17 PM PDT

      [ Parent ]

  •  Medicaid expansion (7+ / 0-)

    not Medicare expansion.

  •  But here's the thing--most of the people (4+ / 0-)
    Recommended by:
    commonmass, jessical, Catte Nappe, MRA NY

    that would qualify for the Medicaid expansion in the red states are White and vote Republican.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sun Jun 09, 2013 at 11:43:10 AM PDT

    •  Even if that's so (and I'd need to see figures) (1+ / 0-)
      Recommended by:

      they're still a drain on the budget.  So, if your'e right, are these people agitating not to give themselves healthcare?

      "I love this goddamn country, and we're going to take it back."

                                                             -- Saul Alinsky

      by Seneca Doane on Sun Jun 09, 2013 at 11:45:39 AM PDT

      [ Parent ]

      •  They would rather do without health care than see (1+ / 0-)
        Recommended by:

        the "undeserving" get it.  They would probably never consider moving to a blue state.  So if that is the demographic most impacted, they are more likely to suffer in place and blame President Obama.

        “The future depends entirely on what each of us does every day.” Gloria Steinem

        by ahumbleopinion on Sun Jun 09, 2013 at 11:58:29 AM PDT

        [ Parent ]

        •  It's medicaid "expansion," not *implementation* (2+ / 0-)
          Recommended by:
          peptabysmal, JamieG from Md

          The very poor already get it.  It the ones just above them to whom it is being expanded.  They're probably still "worth" driving off, though.

          "I love this goddamn country, and we're going to take it back."

                                                                 -- Saul Alinsky

          by Seneca Doane on Sun Jun 09, 2013 at 12:01:50 PM PDT

          [ Parent ]

    •  well then this should give them something to (1+ / 0-)
      Recommended by:
      Seneca Doane

      think about, especially when republican red state sister calls her republican blue state sister who is going to get health care (and she doesn't!).

  •  With emelyn's caveat (8+ / 0-)

    ...agree completely, and this was also one of my first thoughts.  Send the poor to the blue states, snicker snicker.  

    I am less confident than you are about the chances it will work that way, though.  An ebb tide lowers all boats, and modern medical care is a firehose shooting money compared to most individual budgets -- even the smug bastards who think the poor should die will still come up against it, soon or late.  And I actually think it is true that more livable societies are more productive societies -- a lot of the people who need coverage are very far from the bitter option of a hound ticket.  If all your low wage workers leave, you are kind of fucked, even if you are a republican overlord who thinks Jesus will provide and the poor are a resource like oil.

    I think their intent is to simply be so obstructionist that the ACA fails.  I think they might succeed, especially in the face of a rollout rooted in a government culture built around kicking the scummy poor when they come for their ill-deserved handouts.  The idea that 300 million people will be on these exchanges in months, and a huge percentage of them will need legally provided subsidies, doesn't seem to have penetrated (but maybe we're just not seeing it yet, maybe they aren't clueless fucks, we can hope...)

    ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

    by jessical on Sun Jun 09, 2013 at 11:45:03 AM PDT

    •  Far fewer than 300 million will be on exchanges (5+ / 0-)

      If you get medical care through work, as most still will, you won't need to be on an exchange.  And those on Medicaid now won't see a change.

      Sadly, the past five years have also shown that some boats float higher in an ebb tide.  (Extra buoyancy from floating on the blood of the innocent, I guess.)

      "I love this goddamn country, and we're going to take it back."

                                                             -- Saul Alinsky

      by Seneca Doane on Sun Jun 09, 2013 at 11:51:08 AM PDT

      [ Parent ]

      •  Nor those on Medicare. (3+ / 0-)
        Recommended by:
        jessical, Seneca Doane, Chas 981

        “The future depends entirely on what each of us does every day.” Gloria Steinem

        by ahumbleopinion on Sun Jun 09, 2013 at 12:00:01 PM PDT

        [ Parent ]

      •  all true (2+ / 0-)
        Recommended by:
        Seneca Doane, IamGumby

        (though it is still a hella big software rollout which is giving off bad public smells at the moment).  

        Though per your diary, I think the interesting thing will be if the republicans think they are giving the worthless a bus ticket out of town, but instead find those assumptions to be flawed.  And it doesn't have to be my flaw, above -- it could simply be that people like and want a more egalitarian society, when they see one next door and can't have it.  And that this may, to some degree, transcend ideology, when they've heard "she could have got treatment, but Texas..." one too many times.

        Of course, it could go just as you say.  But...

        ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

        by jessical on Sun Jun 09, 2013 at 12:03:43 PM PDT

        [ Parent ]

    •  Not to Mention (0+ / 0-)

      That the current population of the US is not much more than 300 million. (It's 300 + thirteen million. I would have written this numerically, but the number one key on my laptop does not work.)

      One cat away from crazy.

      by IamGumby on Sun Jun 09, 2013 at 01:02:49 PM PDT

      [ Parent ]

  •  This analysis makes sense to me. When you start, (2+ / 0-)
    Recommended by:
    Seneca Doane, jessical

    as the GOP does, with the self-congratulatory presumption that the poor and the sickly are inferior individuals, all subsequent actions taken to separate from the dangers represented by that group seem rational and right.  At base, it's all about the "Benjamins", the dollars that grease the wheels of power.

  •  It won't work (3+ / 0-)
    Recommended by:
    Seneca Doane, splashy, MRA NY

    And far from being senseless -- it may work.

    I doubt it. Most people won't move for that. States generally have residency requirements before you can use state-level benefits. It's not like someone can say, I'll move to Chicago today and get benefits tomorrow. And people have ties to where they live - family, friends, etc. You don't give that up for a supposed benefit you won't get for a good while, if ever.

    The nutjobs might be declining Medicaid expansion on the theory you suggest, but I don't see where it's likely to have any actual effect. It makes a great line for them to lather up their base, but in practical terms I'd guess that's about it.

    •  There are residency requirements for things like (1+ / 0-)
      Recommended by:
      JamieG from Md

      in-state tuition and to take advantage of compassion in dying laws.  As I recall, though, for federally-funded services there aren't -- the Supreme Court has held them to be an infringement on the right to interstate travel -- another of those unenumerated constitutional rights.

      "I love this goddamn country, and we're going to take it back."

                                                             -- Saul Alinsky

      by Seneca Doane on Sun Jun 09, 2013 at 11:55:37 AM PDT

      [ Parent ]

  •  "homelessness" is not a "problem" (7+ / 0-)

    if you move "them" out of town, or even better, out of state.  This may not be obvious to a sheltered Harvard economist, but it is to anyone who has heard the magic words "don't want to see you here after dark, boy . . .".

    Fake Left, Drive Right . . . not my idea of a Democrat . . .

    by Deward Hastings on Sun Jun 09, 2013 at 11:51:53 AM PDT

  •  I see where you're coming from on this and you (4+ / 0-)

    make an interesting argument.  However, do the right wingers really view those who need Medicaid as having no compensating value?  Don't a lot of them do things like staffing day cares or Walmarts?   Aren't a lot of them domestic workers or landscapers.  Surely a significant numer of domestic workers and landscapes are citizens or holders of green cards.  

    Also, Medicaid pays for assisted living and chronic care residences for seniors.  Families might balk at sending their seniors to another state.  

    I can imagine that a few voters (esp. women) might be upset if they can't find day care spaces becaude of understaffing or can't find a weekly cleaning lady or regular lawn and garden services and the like.

    We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

    by Observerinvancouver on Sun Jun 09, 2013 at 11:57:11 AM PDT

  •  yes and if they leave en masse their electoral (1+ / 0-)
    Recommended by:
    Seneca Doane

    votes will go down along with their seats in congress. so let them leave New Orleans style.

  •  The ticket out of town may be for themselves (2+ / 0-)
    Recommended by:
    Seneca Doane, dragonlady

    There is constant speculation that Gov. Perry may want to give the Presidential race another go, and that is driving his partisan decisions.

    “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

    by Catte Nappe on Sun Jun 09, 2013 at 12:21:47 PM PDT

    •  The same is said about Scott Walker (0+ / 0-)

      He spends a lot of time giving speeches and attending fundraisers all over the country while his tame legislature votes against expanding Medicaid (BadgerCare in Wisconsin) to people just above the poverty line because "they can buy coverage from the exchanges." Except that the out-of-pocket expenses would keep people at that level away from the exchanges and push them to the emergency room. So sad.

  •  Worked well last time... (3+ / 0-)
    Give me your tired, your poor,
    Your huddled masses yearning to breathe free,
    The wretched refuse of your teeming shore.
    Send these, the homeless, tempest-tost to me,
    I lift my lamp beside the golden door!
    That worked out incredibly well for the United States and it'll work well for the blue states this time.

    Poor people with enough drive and wherewithal to move to another state are exactly the sort of people you want. The challenges they need to overcome to do so are phenomenal, so if they can do it they'll likely succeed at something.

    They have nothing and expect nothing, but hope for a chance. You give them the chance, they'll give back 10 fold

  •  I just sent a link to your post here to (2+ / 0-)
    Recommended by:
    Seneca Doane, FindingMyVoice

    Krugman at his NYT contact email.

    This is a topic I'm sure he'll be continuing to speak and write about. I just thought it would be a good idea to expose him to your take on it - one that obviously hasn't occurred to him yet.

    WTFWJD? LOTE? I sincerely doubt that.

    by WisePiper on Sun Jun 09, 2013 at 12:53:25 PM PDT

  •  Everyone I know who will be eligible works (3+ / 0-)
    Recommended by:
    Seneca Doane, Chas 981, MRA NY

    so it might not be such a great idea. Low paid workers make things profitable. If states no longer have meat processors and Walmart employees and all the other jobs that pay so little they might not like it so much.

    How big is your personal carbon footprint?

    by ban nock on Sun Jun 09, 2013 at 01:34:55 PM PDT

    •  That's what would-be students who can't afford (1+ / 0-)
      Recommended by:
      ban nock

      college and live with their parents are for.  Unfortunately.

      "I love this goddamn country, and we're going to take it back."

                                                             -- Saul Alinsky

      by Seneca Doane on Sun Jun 09, 2013 at 03:33:54 PM PDT

      [ Parent ]

  •  Also a heck of a lot of people one would normally (3+ / 0-)
    Recommended by:
    Seneca Doane, Chas 981, dragonlady

    consider to be Republicans vote Dem down at the lower end of the income bracket.

    Looking at the demographics for 2008 white people under 30K voted more reliably Obama than any other cohort of white voters. As a whole I'd say the near poor and poor are some of your most stalwart Dems. Dems are the only party that has their interests in mind.

    How big is your personal carbon footprint?

    by ban nock on Sun Jun 09, 2013 at 01:37:43 PM PDT

  •  They're trying to accelerate the rate at which the (2+ / 0-)
    Recommended by:
    Seneca Doane, peptabysmal

    poor and the disabled and the elderly die off.
    A kinder, gentler final solution.
    As a fall-back, yes, the "bus ticket out of town".
    They don't want it for their state now, but in the future they'll be complaining about the fed gov supporting expanded medicaid in other states as well.

    You can't make this stuff up.

    by David54 on Sun Jun 09, 2013 at 03:57:19 PM PDT

  •  I don't think it's a policy objective. (1+ / 0-)
    Recommended by:
    Seneca Doane

    It's just their usual belligerence-- 'don't like it here, then move & be the liberals' problem!'  And if all the people at the bottom of the ladder moved, the people who denigrate them most would be the new bottom-dwellers, and they wouldn't like that at all.  

    Although being from MS originally does make me wonder what the new excuse would be if the third of the population that's AA did pick up & move, because I can tell you right now the state's low quality-of-life rankings would only improve marginally.  A lot of the [white] residents like to suggest that the only reason MS ranks so low is the really poor AA population, but the more comfortable whites aren't exactly knocking themselves out to raise the achievement bar.  Maybe they'd go all socialist once they only had to take care of their own kind, or something.

    "Conservative principles" are marketing props used by the Conservative Movement to achieve political power, not actual beliefs. -Glenn Greenwald

    by latts on Sun Jun 09, 2013 at 04:10:07 PM PDT

  •  There's a weakness in this plan. (1+ / 0-)
    Recommended by:
    Seneca Doane

    Most of those who would be qualified for the Medicaid expansion constitute either the "working poor" or the disabled.  Both populations tend to be IMMOBILIZED by their poverty and have limited ability to move anywhere.  The disabled are dependent on complex networks of multiple health care providers willing to accept minimal payment, and cannot afford to risk loss of care for any significant length of time while they attempt to re-establish those networks in a new location, let alone another state.  The working poor survive on limited cash funds by extensive networks of trade and barter for various supplies and services.  They cannot uproot and move because they lack the funds to maintain even basic living expenses without this network of reciprocity.  They could only move if half of their friends and family moved with them.

    If this is the plan, then it was devised by those who have no experience in dealing with the realities of underclass life and is unlikely to succeed.

    •  All of that may well be true (0+ / 0-)

      They may not know what they're doing, but I'll bet that they hope that it works pretty much as stated.

      "I love this goddamn country, and we're going to take it back."

                                                             -- Saul Alinsky

      by Seneca Doane on Mon Jun 10, 2013 at 04:56:32 AM PDT

      [ Parent ]

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